| NPI | 1174011068 |
|---|---|
| Former Name | JANE CHACKO |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY F338855-1) |
| Additional Taxonomies | 163WM0705X Registered Nurse, Medical-Surgical (Licence: NY 624064-1) |
| Enumeration Date | 2018-04-25 |
| Last Update Date | 2018-11-15 |