Provider Demographics
NPI:1083986608
Name:CHAPERON JEAN-PHILIPPE, JEANNELLE (CNM)
Entity Type:Individual
Prefix:MS
First Name:JEANNELLE
Middle Name:
Last Name:CHAPERON JEAN-PHILIPPE
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:JEANNELLE
Other - Middle Name:
Other - Last Name:CHAPERON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CNM
Mailing Address - Street 1:200 MAIN ST STE 2&6
Mailing Address - Street 2:
Mailing Address - City:SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-2918
Mailing Address - Country:US
Mailing Address - Phone:631-638-4766
Mailing Address - Fax:631-751-2322
Practice Address - Street 1:200 MAIN ST STE 2&6
Practice Address - Street 2:
Practice Address - City:SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-2918
Practice Address - Country:US
Practice Address - Phone:631-638-4766
Practice Address - Fax:631-751-2322
Is Sole Proprietor?:No
Enumeration Date:2012-01-27
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY569086163W00000X
NYF001577367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse