Basic Information
| Provider Information | |||||||||
| NPI: | 1376112813 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHIATOH-GWANMESIA | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | NDUM NJANG | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 851 TRAFALGAR CT STE 200E | ||||||||
| Address2: | |||||||||
| City: | MAITLAND | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327517420 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4076670444 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1000 WATERMAN WAY | ||||||||
| Address2: | |||||||||
| City: | TAVARES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327785266 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3522533595 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2021 | ||||||||
| LastUpdateDate: | 06/13/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/13/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN9409505 | FL | N | Nursing Service Providers | Registered Nurse | 367500000X | APRN11019896 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.