Healthcare Provider Details

I. General information

NPI: 1043130461
Provider Name (Legal Business Name): ISOLDE MAY TAVIZON CNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

760 E 3RD ST
CHADRON NE
69337
US

IV. Provider business mailing address

760 E 3RD ST
CHADRON NE
69337
US

V. Phone/Fax

Practice location:
  • Phone: 303-087-6383
  • Fax:
Mailing address:
  • Phone: 303-087-6383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number173004
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: