Provider Demographics
NPI:1659776052
Name:CHALK, DEBRA (RN, IBCLC, CPD)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:
Last Name:CHALK
Suffix:
Gender:F
Credentials:RN, IBCLC, CPD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 EVERETT AVE
Mailing Address - Street 2:
Mailing Address - City:BOW
Mailing Address - State:NH
Mailing Address - Zip Code:03304-3400
Mailing Address - Country:US
Mailing Address - Phone:603-340-7028
Mailing Address - Fax:603-224-3077
Practice Address - Street 1:3 EVERETT AVE
Practice Address - Street 2:
Practice Address - City:BOW
Practice Address - State:NH
Practice Address - Zip Code:03304-3400
Practice Address - Country:US
Practice Address - Phone:603-340-7028
Practice Address - Fax:603-224-3077
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-28
Last Update Date:2018-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374J00000X
NH018316-21163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No374J00000XNursing Service Related ProvidersDoula