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General NPI Number Information
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NPI Number | 1831528157
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Entity Type | Individual
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Provider Name | CHANTAL ISABEL LOURES NP
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Gender | Female
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Dates
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Enumeration Date | 11/07/2013
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Last Update Date | 09/01/2019
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Provider Practice Location Address
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Address Line | 157-15 46TH AVE
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City | FLUSHING
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State | NY
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Zip | 11355-2353
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Country | US
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Telephone | 718-445-3029
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Fax |
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Provider Business Mailing Address
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Address Line | 125 EAGLE ST APT 2
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City | BROOKLYN
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State | NY
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Zip | 11222-5486
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Country | US
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Telephone | 732-547-2729
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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 | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 383041
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License Number State | NY
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