Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LN0000X | Nurse Practitioner - Neonatal | 774685 | TX |
N | 363LN0000X | Nurse Practitioner - Neonatal | AP05923 | LA |
N | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 774685 | TX |
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | AP05923 | LA |
NPI | 1154656494 |
---|---|
Provider Name | Paul Wesley Chism |
First Address | Shreveport, LA 71101-4343 |
Second Address | Shreveport, LA 71101-4343 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2009 |
Last Update Date | 20/02/2013 |