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General NPI Number Information
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NPI Number | 1881180222
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Entity Type | Individual
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Provider Name | EYMY DIANA CHACON APRN
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Gender | Female
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Dates
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Enumeration Date | 07/09/2018
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Last Update Date | 01/07/2022
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Provider Practice Location Address
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Address Line | 764 CAMPBELL AVE
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City | WEST HAVEN
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State | CT
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Zip | 06516-3786
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Country | US
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Telephone | 203-931-0034
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Fax |
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Provider Business Mailing Address
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Address Line | 3495 PIEDMONT RD NE BLDG 93
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City | ATLANTA
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State | GA
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Zip | 30305-1717
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Country | US
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Telephone | 404-949-5183
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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 | 12
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN285274
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License Number State | GA
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