Healthcare Provider Details

I. General information

NPI: 1063687317
Provider Name (Legal Business Name): LAURA BETH CHALK PCNS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2008
Last Update Date: 03/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 GOVERNOR ST FL 2
PROVIDENCE RI
02906-3246
US

IV. Provider business mailing address

208 GOVERNOR ST FL 2
PROVIDENCE RI
02906-3246
US

V. Phone/Fax

Practice location:
  • Phone: 401-383-4848
  • Fax: 401-383-4811
Mailing address:
  • Phone: 401-383-4848
  • Fax: 401-383-4811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberPPNS00352
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: