Individual
SIBI CHACKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
10325 LAKE JUNE RD, DALLAS, TX 75217-5312
(214) 928-9800
Mailing address
306 SUNSET CT # 18, SUNNYVALE, TX 75182-1003
(214) 418-9216
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
AG03190020
TX
363LG0600X
Gerontology Nurse Practitioner
Primary
AP141408
TX
Other
Enumeration date
05/10/2021
Last updated
05/10/2021
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