Individual
MRS. LISA CHASTAIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
925 HIGHWAY V V, KENNETT, MO 63857-0071
(573) 359-2600
Mailing address
925 HIGHWAY V V, KENNETT, MO 63857-0071
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
2011028017
MO
Other
Enumeration date
09/01/2016
Last updated
09/01/2016
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