=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821738295
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CLAUDIA GUADALUPE CHAVEZ CREP, CCRP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/31/2022
-----------------------------------------------------
Last Update Date | 03/31/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2003 KOOTENAI HEALTH WAY
-----------------------------------------------------
City | COEUR D ALENE
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83814-6051
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-625-4693
-----------------------------------------------------
Fax | 208-625-4692
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2003 KOOTENAI HEALTH WAY
-----------------------------------------------------
City | COEUR D ALENE
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83814-6051
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-625-4693
-----------------------------------------------------
Fax | 208-625-4692
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 224Y00000X
-----------------------------------------------------
Taxonomy Name | Clinical Exercise Physiologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------