Provider Demographics
NPI:1447021415
Name:CHEZIK, THOMAS JOHN (SRNA, RN)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:JOHN
Last Name:CHEZIK
Suffix:
Gender:M
Credentials:SRNA, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8903 WEATHERBY CT
Mailing Address - Street 2:
Mailing Address - City:GRANITE BAY
Mailing Address - State:CA
Mailing Address - Zip Code:95746-6922
Mailing Address - Country:US
Mailing Address - Phone:209-923-7397
Mailing Address - Fax:
Practice Address - Street 1:8903 WEATHERBY CT
Practice Address - Street 2:
Practice Address - City:GRANITE BAY
Practice Address - State:CA
Practice Address - Zip Code:95746-6922
Practice Address - Country:US
Practice Address - Phone:209-923-7397
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-10
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95184037163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse