Basic Information
| Provider Information | |||||||||
| NPI: | 1003146655 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHITMAN-ALLEN | ||||||||
| FirstName: | SUSITA | ||||||||
| MiddleName: | SHAWNTA | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | R.N. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 22119 BRIDGESTONE HAWK CT | ||||||||
| Address2: | |||||||||
| City: | SPRING | ||||||||
| State: | TX | ||||||||
| PostalCode: | 773884663 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2814339298 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 22119 BRIDGESTONE HAWK CT | ||||||||
| Address2: | |||||||||
| City: | SPRING | ||||||||
| State: | TX | ||||||||
| PostalCode: | 773884663 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2814339298 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/04/2010 | ||||||||
| LastUpdateDate: | 01/04/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 374U00000X | N | Nursing Service Related Providers | Home Health Aide | 163W00000X | 704538 | TX | Y | Nursing Service Providers | Registered Nurse |
No ID Information.