Provider Demographics
NPI:1952074122
Name:PETIT-FRERE, CHRISLENE
Entity Type:Individual
Prefix:
First Name:CHRISLENE
Middle Name:
Last Name:PETIT-FRERE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4268 NW 37TH TER
Mailing Address - Street 2:
Mailing Address - City:LAUDERDALE LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33309-4150
Mailing Address - Country:US
Mailing Address - Phone:954-205-6982
Mailing Address - Fax:
Practice Address - Street 1:4268 NW 37TH TER
Practice Address - Street 2:
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33309-4150
Practice Address - Country:US
Practice Address - Phone:954-205-6982
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-26
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL406618376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide