Provider Demographics
NPI:1598413668
Name:CHASE, IRINA (RN, MSN, NP, IBCLC)
Entity Type:Individual
Prefix:
First Name:IRINA
Middle Name:
Last Name:CHASE
Suffix:
Gender:F
Credentials:RN, MSN, NP, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1107 CARDIGAN DR
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-6441
Mailing Address - Country:US
Mailing Address - Phone:925-324-7796
Mailing Address - Fax:
Practice Address - Street 1:1107 CARDIGAN DR
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-6441
Practice Address - Country:US
Practice Address - Phone:925-324-7796
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-16
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA706610163W00000X, 163WN0002X, 163WL0100X
CA23815363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner