Provider Demographics
NPI:1225380769
Name:CHASSAGNE, LISA (RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:CHASSAGNE
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1304 MARQUIS CT
Mailing Address - Street 2:
Mailing Address - City:FALLSTON
Mailing Address - State:MD
Mailing Address - Zip Code:21047-2265
Mailing Address - Country:US
Mailing Address - Phone:410-989-1014
Mailing Address - Fax:
Practice Address - Street 1:1304 MARQUIS CT
Practice Address - Street 2:
Practice Address - City:FALLSTON
Practice Address - State:MD
Practice Address - Zip Code:21047-2265
Practice Address - Country:US
Practice Address - Phone:410-989-1014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-08
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR099592163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant