Healthcare Provider Details

I. General information

NPI: 1437395092
Provider Name (Legal Business Name): NICOLE M. CHAVEZ N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/31/2008
Last Update Date: 08/12/2022
Certification Date: 06/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 COLE AVE
BISBEE AZ
85603-1327
US

IV. Provider business mailing address

101 COLE AVE
BISBEE AZ
85603-1327
US

V. Phone/Fax

Practice location:
  • Phone: 520-432-6481
  • Fax: 520-432-5082
Mailing address:
  • Phone: 520-432-6481
  • Fax: 520-432-5082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP3184
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: