Provider Demographics
NPI:1194203885
Name:JOSEPH AUGUSTE, CHANTALE (LPN)
Entity Type:Individual
Prefix:
First Name:CHANTALE
Middle Name:
Last Name:JOSEPH AUGUSTE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 CHEEVER ST
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:MA
Mailing Address - Zip Code:02186-1126
Mailing Address - Country:US
Mailing Address - Phone:857-204-5363
Mailing Address - Fax:
Practice Address - Street 1:55 CHEEVER ST
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:MA
Practice Address - Zip Code:02186-1126
Practice Address - Country:US
Practice Address - Phone:857-204-5363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-03
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALN68881251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care