Provider Demographics
NPI:1740870633
Name:CHESNUT, MADELEINE LIZA
Entity type:Individual
Prefix:
First Name:MADELEINE
Middle Name:LIZA
Last Name:CHESNUT
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 1:14 ADAMS DR
Mailing Address - Street 2:
Mailing Address - City:BETHEL
Mailing Address - State:CT
Mailing Address - Zip Code:06801-1111
Mailing Address - Country:US
Mailing Address - Phone:301-343-9889
Mailing Address - Fax:
Practice Address - Street 1:14 ADAMS DR
Practice Address - Street 2:
Practice Address - City:BETHEL
Practice Address - State:CT
Practice Address - Zip Code:06801-1111
Practice Address - Country:US
Practice Address - Phone:301-343-9889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-25
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT128795163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse