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General NPI Number Information
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NPI Number | 1033267174
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Entity Type | Individual
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Provider Name | JULIA REBEKAH THEODORA CHACHERE NP, CNM
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Gender | Female
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Dates
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Enumeration Date | 01/08/2007
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Last Update Date | 08/21/2019
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Provider Practice Location Address
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Address Line | NORTH FORK FAMILY PRACTICE 32845 MAIN ROAD
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City | CUTCHOGUE
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State | NY
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Zip | 11935
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Country | US
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Telephone | 631-405-3235
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Fax | 631-259-0298
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Provider Business Mailing Address
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Address Line | PECONIC BAY PRIMARY CARE P.O. BOX 2377
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City | RIVERHEAD
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State | NY
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Zip | 11901
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Country | US
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Telephone | 631-298-4479
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Fax | 631-259-0298
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 176B00000X
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Taxonomy Name | Midwife
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License Number | F001238-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 176B00000X
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Taxonomy Name | Midwife
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License Number | F001238
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | F420821
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License Number State | NY
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