Provider Demographics
NPI:1447859848
Name:CHETANGIE, EUGENIE KOTTIN
Entity type:Individual
Prefix:
First Name:EUGENIE
Middle Name:KOTTIN
Last Name:CHETANGIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 ROLLING RAPIDS CT
Mailing Address - Street 2:
Mailing Address - City:HACKETTSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07840-1736
Mailing Address - Country:US
Mailing Address - Phone:862-216-9422
Mailing Address - Fax:
Practice Address - Street 1:13 ROLLING RAPIDS CT
Practice Address - Street 2:
Practice Address - City:HACKETTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07840-1736
Practice Address - Country:US
Practice Address - Phone:862-216-9422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-19
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01063000363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily