Healthcare Provider Details

I. General information

NPI: 1841694015
Provider Name (Legal Business Name): RENE CHAVEZ MOYA DNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2014
Last Update Date: 04/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

608 N 1ST ST
ARTESIA NM
88210-1402
US

IV. Provider business mailing address

608 N 1ST ST
ARTESIA NM
88210-1402
US

V. Phone/Fax

Practice location:
  • Phone: 575-746-2416
  • Fax:
Mailing address:
  • Phone: 575-746-2416
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberCNP-02512
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: