Provider Demographics
NPI:1447096474
Name:CHESSER, POLLY LOU (RN)
Entity type:Individual
Prefix:
First Name:POLLY
Middle Name:LOU
Last Name:CHESSER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13149 US HIGHWAY 223
Mailing Address - Street 2:
Mailing Address - City:MANITOU BEACH
Mailing Address - State:MI
Mailing Address - Zip Code:49253-9521
Mailing Address - Country:US
Mailing Address - Phone:517-442-9506
Mailing Address - Fax:
Practice Address - Street 1:13149 US HIGHWAY 223
Practice Address - Street 2:
Practice Address - City:MANITOU BEACH
Practice Address - State:MI
Practice Address - Zip Code:49253-9521
Practice Address - Country:US
Practice Address - Phone:517-442-9506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-09
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704202125163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse