Healthcare Provider Details

I. General information

NPI: 1891098265
Provider Name (Legal Business Name): LEA C CHIAVARAS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2010
Last Update Date: 10/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9201 E MOUNTAIN VIEW RD STE 220
SCOTTSDALE AZ
85258-5199
US

IV. Provider business mailing address

PO BOX 6369
HELENA MT
59604-6369
US

V. Phone/Fax

Practice location:
  • Phone: 877-561-7335
  • Fax:
Mailing address:
  • Phone: 406-457-4180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR 169354-2
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberR 169354-2
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberNUR-RN-LIC-74637
License Number StateMT
# 4
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberNUR-RN-LIC-74637
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: