Healthcare Provider Details

I. General information

NPI: 1164032397
Provider Name (Legal Business Name): DANIEL HARRY CHASE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2020
Last Update Date: 07/17/2025
Certification Date: 07/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4076 NEELY ROAD
FORT WAINWRIGHT AK
99703
US

IV. Provider business mailing address

274 HAWTHORNE ST
FALL RIVER MA
02721-3108
US

V. Phone/Fax

Practice location:
  • Phone: 803-751-2160
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberRN2317489
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN02411
License Number StateRI
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN2317489
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: