Basic Information
| Provider Information | |||||||||
| NPI: | 1003142662 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NASH-CHAGULA | ||||||||
| FirstName: | TRACEY | ||||||||
| MiddleName: | A. | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | I | ||||||||
| Credential: | R. N. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3323 | ||||||||
| Address2: | |||||||||
| City: | MOUNT VERNON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105533323 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 1914439447 | ||||||||
| FaxNumber: | 9144394474 | ||||||||
| Practice Location | |||||||||
| Address1: | 4328 DEREIMER AVENUE | ||||||||
| Address2: | PVT | ||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104661820 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9144394474 | ||||||||
| FaxNumber: | 9144394474 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/02/2009 | ||||||||
| LastUpdateDate: | 11/02/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 486559-1 | NY | Y | Nursing Service Providers | Registered Nurse |
No ID Information.