Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 0101261536 | VA |
Y | 111NI0900X | Internist | 0101261536 | VA |
NPI | 1003202508 |
---|---|
Provider Name | Erin Amanda Chicoine |
First Address | Jbsa Lackland, TX 78236-5638 |
Second Address | Jbsa Lackland, TX 78236-9908 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2015 |
Last Update Date | 19/08/2019 |