Healthcare Provider Details

I. General information

NPI: 1043973068
Provider Name (Legal Business Name): CHAVONDA C HAYSE LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2021
Last Update Date: 10/17/2021
Certification Date: 10/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 FOUNTAIN VIEW DR STE 224
HOUSTON TX
77057-4819
US

IV. Provider business mailing address

19138 LARKSPUR HILLS DR
CYPRESS TX
77433-1947
US

V. Phone/Fax

Practice location:
  • Phone: 937-504-2240
  • Fax:
Mailing address:
  • Phone: 832-349-1333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code342000000X
TaxonomyTransportation Network Company
License Number
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: