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General NPI Number Information
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NPI Number | 1801995568
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Entity Type | Individual
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Provider Name | TRICIA MARIE CHAVEZ FNP
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Gender | Female
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Dates
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Enumeration Date | 09/21/2006
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Last Update Date | 12/19/2016
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Provider Practice Location Address
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Address Line | 11075 S STATE ST STE 33
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City | SANDY
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State | UT
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Zip | 84070-5183
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Country | US
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Telephone | 801-572-5833
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Fax | 801-572-5844
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Provider Business Mailing Address
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Address Line | 11075 S STATE ST STE 33
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City | SANDY
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State | UT
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Zip | 84070-5183
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Country | US
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Telephone | 801-572-5833
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Fax | 801-572-5844
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 537760
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License Number State | CA
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