Provider Demographics
NPI:1386991222
Name:CHENAULT, KAABA (RN, IBCLC, CCE)
Entity type:Individual
Prefix:MS
First Name:KAABA
Middle Name:
Last Name:CHENAULT
Suffix:
Gender:F
Credentials:RN, IBCLC, CCE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 FRANCIS MILLS RD
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-7945
Mailing Address - Country:US
Mailing Address - Phone:917-226-8023
Mailing Address - Fax:732-252-6208
Practice Address - Street 1:7 FRANCIS MILLS RD
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-7945
Practice Address - Country:US
Practice Address - Phone:917-226-8023
Practice Address - Fax:732-252-6208
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-09
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY503171163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant