Basic Information
Provider Information
NPI: 1003146655
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CHITMAN-ALLEN
FirstName: SUSITA
MiddleName: SHAWNTA
NamePrefix: MRS.
NameSuffix:  
Credential: R.N.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
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
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
163W00000X704538TXY Nursing Service ProvidersRegistered Nurse 
374U00000X  N Nursing Service Related ProvidersHome Health Aide 

No ID Information.


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