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General NPI Number Information
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NPI Number | 1982315529
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Entity Type | Organization
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Legal Business Name | CHRYSALIS CHILDREN'S CLINIC, PLLC
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Dates
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Enumeration Date | 12/05/2022
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Last Update Date | 12/05/2022
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Provider Practice Location Address
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Address Line | 1845 E BROADWAY RD STE 116
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City | TEMPE
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State | AZ
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Zip | 85282-1685
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Country | US
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Telephone | 602-851-5353
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Fax |
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Provider Business Mailing Address
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Address Line | 6847 S ALDER DR
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City | TEMPE
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State | AZ
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Zip | 85283-4148
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Country | US
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Telephone | 623-570-7829
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Fax |
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Authorized Official
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Title or Position | CEO/PEDIATRIC NURSE PRACTITIONER
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Name | ANGELA J CABRERA
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Credential | APRN
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Telephone | 623-570-7829
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number |
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License Number State |
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