Individual
SUSAN CHACKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
5200 HARRY HINES BLVD, DALLAS, TX 75235-7709
(516) 941-7930
Mailing address
1024 BLUE HERON DR, FORNEY, TX 75126-8311
(516) 941-7930
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
AP140734
TX
Other
Enumeration date
12/20/2020
Last updated
12/20/2020
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