MEDICARE: MS. JULIA REBEKAH THEODORA CHACHERE NP, CNM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	176B00000X	Midwife	F001238-1	NY
2	176B00000X	Midwife	F001238	NY
3	363LW0102X	Women's Health Nurse Practitioner	F420821	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033267174
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JULIA REBEKAH THEODORA CHACHERE NP, CNM

Provider Business Mailing Address
First Line	:	PECONIC BAY PRIMARY CARE
Second Line	:	P.O. BOX 2377
City	:	RIVERHEAD
State	:	NY
Zip	:	11901
Country	:	US
Telephone Number	:	631-298-4479
Fax Number	:	631-259-0298

Provider Business Practice Location Address
First Line	:	NORTH FORK FAMILY PRACTICE
Second Line	:	32845 MAIN ROAD
City	:	CUTCHOGUE
State	:	NY
Zip	:	11935
Country	:	US
Telephone Number	:	631-405-3235
Fax Number	:	631-259-0298

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	08/21/2019

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