Individual
CHETAUN C CAPTAIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
10260 PEACOCK LN, MIAMISBURG, OH 45342-0876
(937) 367-3058
Mailing address
10260 PEACOCK LN, MIAMISBURG, OH 45342-0876
(937) 367-3058
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN145064
OH
Other
Enumeration date
08/04/2011
Last updated
08/04/2011
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