Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | R205123 | MD |
NPI | 1053084186 |
---|---|
Provider Name | Mrs. Natasha Chinakesha Decaires-Chester |
First Address | Waldorf, MD 20603-7019 |
Second Address | La Plata, MD 20646-5960 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2021 |
Last Update Date | 26/07/2021 |