Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | 26245 | MS |
Y | 207ND0101X | MOHS-Micrographic Surgeon | 26245 | MS |
N | 208D00000X | General Practice Physician | C1-0009800 | DE |
NPI | 1144545195 |
---|---|
Provider Name | Dr. Lisa Renee Chastant |
First Address | Keesler Afb, MS 39534-2519 |
Second Address | Keesler Afb, MS 39534-2519 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/04/2010 |
Last Update Date | 21/08/2019 |