Provider Demographics
NPI:1760593792
Name:CHAPDELAINE, SALLY A (RNCS)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:A
Last Name:CHAPDELAINE
Suffix:
Gender:F
Credentials:RNCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 PASTURE RD
Mailing Address - Street 2:
Mailing Address - City:ROCKPORT
Mailing Address - State:MA
Mailing Address - Zip Code:01966-1321
Mailing Address - Country:US
Mailing Address - Phone:987-546-3073
Mailing Address - Fax:978-546-2045
Practice Address - Street 1:5 PASTURE RD
Practice Address - Street 2:
Practice Address - City:ROCKPORT
Practice Address - State:MA
Practice Address - Zip Code:01966-1321
Practice Address - Country:US
Practice Address - Phone:987-546-3073
Practice Address - Fax:978-546-2045
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2008-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA90997163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA708151OtherTUFTS HEALTH PLAN
MAPN0015OtherBCBSMA
MAPN0015OtherBCBSMA