Basic Information
Provider Information
NPI: 1003142662
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: NASH-CHAGULA
FirstName: TRACEY
MiddleName: A.
NamePrefix: MRS.
NameSuffix: I
Credential: R. N.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
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
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
163W00000X486559-1NYY Nursing Service ProvidersRegistered Nurse 

No ID Information.


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