Provider Demographics
NPI:1881961175
Name:DEFREESE, CHAWNA N (LPN)
Entity type:Individual
Prefix:
First Name:CHAWNA
Middle Name:N
Last Name:DEFREESE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 CHESTNUT AVE
Mailing Address - Street 2:
Mailing Address - City:HILLBURN
Mailing Address - State:NY
Mailing Address - Zip Code:10931-0363
Mailing Address - Country:US
Mailing Address - Phone:845-729-4141
Mailing Address - Fax:
Practice Address - Street 1:18 CHESTNUT AVE
Practice Address - Street 2:
Practice Address - City:HILLBURN
Practice Address - State:NY
Practice Address - Zip Code:10931-0363
Practice Address - Country:US
Practice Address - Phone:845-729-4141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-30
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY281076-1164W00000X
NJ26NP05873600164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse