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General NPI Number Information
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NPI Number | 1093541195
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Entity Type | Individual
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Provider Name | MARIA ANN MENDRINOS CHAVOUS NP
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Gender | Female
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Dates
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Enumeration Date | 09/13/2024
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Last Update Date | 01/24/2025
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Provider Practice Location Address
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Address Line | 1 MEDICAL CENTER DRIVE MEADE HALL GROUND FLOOR
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City | WINSTON SALEM
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State | NC
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Zip | 27157-4331
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Country | US
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Telephone | 833-832-5669
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Fax |
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Provider Business Mailing Address
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Address Line | 2123 ROCKFORD STREET SUITE 300 #1018
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City | MOUNT AIRY
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State | NC
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Zip | 27030
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Country | US
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Telephone | 203-836-1988
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 5020835
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 363LX0106X
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Taxonomy Name | Occupational Health Nurse Practitioner
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License Number | 5020835
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License Number State | NC
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