Provider Demographics
NPI:1295413649
Name:PEGUERO, CHANELLE RENEE
Entity type:Individual
Prefix:
First Name:CHANELLE
Middle Name:RENEE
Last Name:PEGUERO
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 1:69 FOUNTAIN ST
Mailing Address - Street 2:
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-1242
Mailing Address - Country:US
Mailing Address - Phone:401-390-4948
Mailing Address - Fax:
Practice Address - Street 1:69 FOUNTAIN ST
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-1242
Practice Address - Country:US
Practice Address - Phone:401-390-4948
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-06
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula