Provider Demographics
NPI:1396243507
Name:CHASE, IOVANNA XIOMARA
Entity type:Individual
Prefix:
First Name:IOVANNA
Middle Name:XIOMARA
Last Name:CHASE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:IOVANNA
Other - Middle Name:XIOMARA
Other - Last Name:CHASE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:11088 BAUMANN AVE # B
Mailing Address - Street 2:
Mailing Address - City:FORT CAMPBELL
Mailing Address - State:KY
Mailing Address - Zip Code:42223-6047
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11088 BAUMANN AVE # B
Practice Address - Street 2:
Practice Address - City:FORT CAMPBELL
Practice Address - State:KY
Practice Address - Zip Code:42223-6047
Practice Address - Country:US
Practice Address - Phone:609-351-5117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-23
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1396243507OtherTHEFINDINGMEMOMMY, LLC