MEDICARE: BRENDA LEE CHALOUX

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	363LF0000X	Family Nurse Practitioner	RN198146	MA
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	RN198146	MA

General Provider Information

NPI Number	:	1588113328
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENDA LEE CHALOUX

Provider Business Mailing Address
First Line	:	305 GENERAL KNOX RD
Second Line	:
City	:	RUSSELL
State	:	MA
Zip	:	01071-9741
Country	:	US
Telephone Number	:	413-348-6089
Fax Number	:

Provider Business Practice Location Address
First Line	:	777 NORTH ST STE 305
Second Line	:
City	:	PITTSFIELD
State	:	MA
Zip	:	01201-4172
Country	:	US
Telephone Number	:	413-243-0577
Fax Number	:	413-499-8560

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

Provider Enumeration Date	:	09/21/2016
Last Update Date	:	01/06/2026

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Directions to “ BRENDA LEE CHALOUX ” Practice Location

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