Provider Demographics
NPI:1467162701
Name:HALE, CHANTEL NICOLA (FNP-BC)
Entity Type:Individual
Prefix:
First Name:CHANTEL
Middle Name:NICOLA
Last Name:HALE
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 STRAUBE CENTER BLVD STE 112
Mailing Address - Street 2:
Mailing Address - City:PENNINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08534-1467
Mailing Address - Country:US
Mailing Address - Phone:609-228-5711
Mailing Address - Fax:
Practice Address - Street 1:1 STRAUBE CENTER BLVD STE 112
Practice Address - Street 2:
Practice Address - City:PENNINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08534-1467
Practice Address - Country:US
Practice Address - Phone:609-228-5711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-28
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01399100207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0Medicaid