Provider Demographics
NPI:1912059981
Name:SMITH, CHALLIS H (RN)
Entity Type:Individual
Prefix:MS
First Name:CHALLIS
Middle Name:H
Last Name:SMITH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1836 TIMBERWOOD LN
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-2842
Mailing Address - Country:US
Mailing Address - Phone:757-961-6583
Mailing Address - Fax:757-961-6593
Practice Address - Street 1:MCDONALD ARMY HEALTH CENTER
Practice Address - Street 2:576 JEFFERSON AVE
Practice Address - City:FORT EUSTIS
Practice Address - State:VA
Practice Address - Zip Code:23604-5548
Practice Address - Country:US
Practice Address - Phone:757-314-7522
Practice Address - Fax:757-314-7520
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001072657163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management