Provider Demographics
NPI:1528615200
Name:WESTBROOKS, CHANTEL (LPN)
Entity type:Individual
Prefix:
First Name:CHANTEL
Middle Name:
Last Name:WESTBROOKS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4730 W CAMPBELL AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85031-1404
Mailing Address - Country:US
Mailing Address - Phone:602-246-5155
Mailing Address - Fax:
Practice Address - Street 1:4730 W CAMPBELL AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85031-1404
Practice Address - Country:US
Practice Address - Phone:602-246-5155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-19
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLP050533164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZNOTHINGMedicaid
AZNAMedicaid