Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 176B00000X | Midwife | F001238 | NY |
N | 176B00000X | Midwife | F001238-1 | NY |
Y | 363LW0102X | Nurse Practitioner - Women's Health | F420821 | NY |
NPI | 1033267174 |
---|---|
Provider Name | Ms. Julia Rebekah Theodora Chachere |
First Address | Riverhead, NY 11901 |
Second Address | Cutchogue, NY 11935 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/01/2007 |
Last Update Date | 21/08/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02912783 | (05) | NY |