1104585769 NPI number — CAITLIN CHRISTINE CHARETTE-ZALEWSKI MS, CPNP

Table of content: CAITLIN CHRISTINE CHARETTE-ZALEWSKI MS, CPNP (NPI 1104585769)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104585769 NPI number — CAITLIN CHRISTINE CHARETTE-ZALEWSKI MS, CPNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHARETTE-ZALEWSKI
Provider First Name:
CAITLIN
Provider Middle Name:
CHRISTINE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS, CPNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104585769
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/10/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
22 MANOLA ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICOPEE
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01020-4465
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-244-2725
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1117 NW HIGHWAY 41
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
JASPER
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32052
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
386-792-3864
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/10/2021

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP0200X , with the licence number:  APRN11014463 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 112928100 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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