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General NPI Number Information
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NPI Number | 1821226564
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Entity Type | Organization
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Legal Business Name | ESTELLE CHAMBLIN-MOUSSIGNAC
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Dates
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Enumeration Date | 07/01/2009
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Last Update Date | 07/01/2009
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Provider Practice Location Address
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Address Line | 15 ANTWERP ST
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City | BRIGHTON
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State | MA
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Zip | 02135-1301
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Country | US
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Telephone | 617-562-6090
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Fax |
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Provider Business Mailing Address
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Address Line | 15 ANTWERP ST
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City | BRIGHTON
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State | MA
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Zip | 02135-1301
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Country | US
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Telephone | 617-562-6090
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Fax |
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Authorized Official
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Title or Position | PRIVATE DUTY NURSING
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Name | MRS. ESTELLE CHAMBLIN-MOUSSIGNAC
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Credential | RN
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Telephone | 517-562-6090
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3140N1450X
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Taxonomy Name | Pediatric Skilled Nursing Facility
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License Number | 261062
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License Number State | MA
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