Healthcare Provider Details

I. General information

NPI: 1083422000
Provider Name (Legal Business Name): CHELSAE RENAE URRABAZO BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/23/2024
Last Update Date: 12/23/2024
Certification Date: 12/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

586 COUNTY ROAD 761
DEVINE TX
78016-4425
US

IV. Provider business mailing address

586 COUNTY ROAD 761
DEVINE TX
78016-4425
US

V. Phone/Fax

Practice location:
  • Phone: 830-480-0088
  • Fax: 877-709-0163
Mailing address:
  • Phone: 830-480-0088
  • Fax: 877-709-0163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1017614
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: