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General NPI Number Information
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NPI Number | 1659255743
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Entity Type | Individual
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Provider Name | CHANELLE THOM
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Gender | Female
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Dates
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Enumeration Date | 08/02/2025
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Last Update Date | 08/02/2025
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Provider Practice Location Address
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Address Line | 19 LYONS AVE APT 412
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City | NEWARK
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State | NJ
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Zip | 07112-2441
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Country | US
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Telephone | 551-804-6976
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Fax |
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Provider Business Mailing Address
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Address Line | 19 LYONS AVE APT 412
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City | NEWARK
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State | NJ
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Zip | 07112-2441
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Country | US
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Telephone | 551-804-6976
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Fax |
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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 | 374J00000X
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Taxonomy Name | Doula
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License Number |
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License Number State | NY
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