Provider Demographics
NPI:1487261921
Name:RATLIFF, CHANTRISE N
Entity type:Individual
Prefix:
First Name:CHANTRISE
Middle Name:N
Last Name:RATLIFF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHANTRISE
Other - Middle Name:
Other - Last Name:RATLIFF
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CK PROFESSIONAL GR
Mailing Address - Street 1:553 JESSICA CIR
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-3761
Mailing Address - Country:US
Mailing Address - Phone:757-513-0788
Mailing Address - Fax:
Practice Address - Street 1:553 JESSICA CIR
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-3761
Practice Address - Country:US
Practice Address - Phone:757-513-0788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-29
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver