Healthcare Provider Details

I. General information

NPI: 1316713837
Provider Name (Legal Business Name): MELANIE V CHEVARIE LM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2023
Last Update Date: 11/27/2023
Certification Date: 11/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 DON GASPAR AVE
SANTA FE NM
87505-2660
US

IV. Provider business mailing address

1101 DON GASPAR AVE
SANTA FE NM
87505-2660
US

V. Phone/Fax

Practice location:
  • Phone: 505-231-5110
  • Fax:
Mailing address:
  • Phone: 505-231-5110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number20006R
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: