Basic Information
Provider Information | |||||||||
NPI: | 1194726497 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | CHEVARIE | ||||||||
FirstName: | JANET | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | ARNP | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 133 PLEASANT ST | ||||||||
Address2: |   | ||||||||
City: | BERLIN | ||||||||
State: | NH | ||||||||
PostalCode: | 035702006 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6037522040 | ||||||||
FaxNumber: | 6037527797 | ||||||||
Practice Location | |||||||||
Address1: | 133 PLEASANT ST | ||||||||
Address2: |   | ||||||||
City: | BERLIN | ||||||||
State: | NH | ||||||||
PostalCode: | 035702006 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6037522040 | ||||||||
FaxNumber: | 6037527797 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/09/2005 | ||||||||
LastUpdateDate: | 08/22/2013 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LW0102X | 01521823 | NH | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health |
ID Information
ID | Type | State | Issuer | Description | 020350051 | 01 |   | FEDERAL TAX ID | OTHER | 3071863 | 05 | NH |   | MEDICAID | 30005540 | 05 | NH |   | MEDICAID | 4008425Y0NH01 | 01 | NH | ANTHEM BC/BS | OTHER | MC0050283 | 01 |   | FEDERAL DEA # | OTHER | 1600910 | 01 | NH | CIGNA HEALTHCARE | OTHER | 01521823 | 01 | NH | STATE LICENSE # | OTHER | 5830418 | 01 |   | AETNA GROUP | OTHER |