MEDICARE: DR. IRENE V CHASEN

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	1223G0001X	General Practice Dentistry	DE00009774	WA

General Provider Information

NPI Number	:	1902022155
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IRENE V CHASEN

Provider Business Mailing Address
First Line	:	1221 W MAIN ST
Second Line	:
City	:	MONROE
State	:	WA
Zip	:	98272-2028
Country	:	US
Telephone Number	:	360-794-5788
Fax Number	:

Provider Business Practice Location Address
First Line	:	1221 W MAIN ST
Second Line	:
City	:	MONROE
State	:	WA
Zip	:	98272-2028
Country	:	US
Telephone Number	:	360-794-5788
Fax Number	:

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

Provider Enumeration Date	:	04/17/2007
Last Update Date	:	06/05/2014

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