Individual
CHANDA BROCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
10 EDWARDS DR APT 5, SWANSEA, IL 62226-8204
(618) 570-1401
Mailing address
10 EDWARDS DR APT 5, SWANSEA, IL 62226-8204
(618) 570-1401
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
2005009072
MO
Other
Enumeration date
06/14/2011
Last updated
06/14/2011
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