Provider Demographics
NPI:1902164833
Name:CHETWYND, ELLEN MARIE (RN BSN IBCLC MPH PHD)
Entity Type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:MARIE
Last Name:CHETWYND
Suffix:
Gender:F
Credentials:RN BSN IBCLC MPH PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:3515 HAMLETS CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:PITTSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27312-7129
Mailing Address - Country:US
Mailing Address - Phone:919-967-6960
Mailing Address - Fax:
Practice Address - Street 1:111 KNOX WAY STE 110
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27516-6615
Practice Address - Country:US
Practice Address - Phone:919-438-2293
Practice Address - Fax:833-523-2335
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-28
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174N00000X
NC115961163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Multi-Specialty