Provider Demographics
NPI:1841235470
Name:CHACE, JENNIFER KAY (MSAPRN)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:KAY
Last Name:CHACE
Suffix:
Gender:F
Credentials:MSAPRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 VETERANS MEMORIAL PKWY
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:RI
Mailing Address - Zip Code:02915-5061
Mailing Address - Country:US
Mailing Address - Phone:401-432-1359
Mailing Address - Fax:401-432-1500
Practice Address - Street 1:1011 VETERANS MEMORIAL PKWY
Practice Address - Street 2:
Practice Address - City:EAST PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02915-5061
Practice Address - Country:US
Practice Address - Phone:401-432-1359
Practice Address - Fax:401-432-1500
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPPNS00067364SP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0807XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI410333OtherBLUE CHIP
RI21495-5OtherBLUE CROSS
RIJC47154Medicaid
RI211412OtherUNITED BEHAVIORAL HEALTH