Provider Demographics
NPI:1659159424
Name:CHASE, JEFFREY (RN)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:CHASE
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 71
Mailing Address - Street 2:
Mailing Address - City:CONEWANGO VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:14726-0071
Mailing Address - Country:US
Mailing Address - Phone:716-485-3591
Mailing Address - Fax:
Practice Address - Street 1:150 PRATHER AVE
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701-6710
Practice Address - Country:US
Practice Address - Phone:716-488-1921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-21
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY482163163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice