Healthcare Provider Details

I. General information

NPI: 1467003665
Provider Name (Legal Business Name): ERIKA CHAVEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2019
Last Update Date: 09/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1313 E RANDOLPH CT APT D
MILWAUKEE WI
53212-1857
US

IV. Provider business mailing address

PO BOX 510012
MILWAUKEE WI
53203-0011
US

V. Phone/Fax

Practice location:
  • Phone: 414-791-9050
  • Fax:
Mailing address:
  • Phone: 414-791-9050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: