Healthcare Provider Details

I. General information

NPI: 1356287858
Provider Name (Legal Business Name): BERNADETTE CHAVEZ RN, CDCES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 SAINT MICHAELS DR
SANTA FE NM
87505-7601
US

IV. Provider business mailing address

5917 CAMINO SAN CARLOS
SANTA FE NM
87507-2733
US

V. Phone/Fax

Practice location:
  • Phone: 505-913-5763
  • Fax: 505-913-6403
Mailing address:
  • Phone: 505-913-5763
  • Fax: 505-913-6403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number21110078
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: