Individual
MISS CHANELLE EASTMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
924 LACKAWANNA AVE, ELMIRA, NY 14901-1525
(607) 333-4033
Mailing address
924 LACKAWANNA AVE, ELMIRA, NY 14901-1525
(607) 333-4033
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
324881
NY
Other
Enumeration date
01/05/2017
Last updated
01/05/2017
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