MEDICARE: JOSEE CHARDAVOINE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	F3045951	NY

General Provider Information

NPI Number	:	1477871804
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEE CHARDAVOINE

Provider Business Mailing Address
First Line	:	21814 HEMPSTEAD AVE
Second Line	:
City	:	QUEENS VILLAGE
State	:	NY
Zip	:	11429-1235
Country	:	US
Telephone Number	:	718-776-3059
Fax Number	:	718-776-3059

Provider Business Practice Location Address
First Line	:	21814 HEMPSTEAD AVE
Second Line	:
City	:	QUEENS VILLAGE
State	:	NY
Zip	:	11429-1235
Country	:	US
Telephone Number	:	718-776-3059
Fax Number	:	718-776-3059

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/10/2010
Last Update Date	:	05/10/2010

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