Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | LPO86 | OK |
N | 222Z00000X | Podiatrist | LPO86 | OK |
Y | 224P00000X | Prosthetist | LPO86 | OK |
NPI | 1144577909 |
---|---|
Provider Name | Mr. Nicholas J Chelenza III |
First Address | Lawton, OK 73501-3661 |
Second Address | Lawton, OK 73501-3661 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2012 |
Last Update Date | 15/01/2013 |