Provider Demographics
NPI:1881405470
Name:JEREMIE, CHANTALE (RN)
Entity type:Individual
Prefix:MS
First Name:CHANTALE
Middle Name:
Last Name:JEREMIE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:CHANTALE
Other - Middle Name:
Other - Last Name:JEAN MARY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:507 CLARENDON RD
Mailing Address - Street 2:
Mailing Address - City:UNIONDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11553-2105
Mailing Address - Country:US
Mailing Address - Phone:347-371-1461
Mailing Address - Fax:
Practice Address - Street 1:2811 QUEENS PLZ N FL 5
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11101-4172
Practice Address - Country:US
Practice Address - Phone:718-391-8300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-14
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY691513163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool