Provider Demographics
NPI:1487328472
Name:CHISNELL, JOSHUA LEE
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:LEE
Last Name:CHISNELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 259
Mailing Address - Street 2:
Mailing Address - City:NAPAVINE
Mailing Address - State:WA
Mailing Address - Zip Code:98565-0259
Mailing Address - Country:US
Mailing Address - Phone:360-262-3320
Mailing Address - Fax:
Practice Address - Street 1:115 E. WASHINGTON ST.
Practice Address - Street 2:
Practice Address - City:NAPAVINE
Practice Address - State:WA
Practice Address - Zip Code:98565
Practice Address - Country:US
Practice Address - Phone:360-262-3320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-04
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAES60606567146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic