MEDICARE: NATALIE CHAVEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172V00000X	Community Health Worker	THW000104050	OR

General Provider Information

NPI Number	:	1053903393
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATALIE CHAVEZ

Provider Business Mailing Address
First Line	:	715 SW 4TH ST STE C
Second Line	:
City	:	MADRAS
State	:	OR
Zip	:	97741-1022
Country	:	US
Telephone Number	:	541-475-4456
Fax Number	:	541-475-0132

Provider Business Practice Location Address
First Line	:	715 SW 4TH ST STE C
Second Line	:
City	:	MADRAS
State	:	OR
Zip	:	97741-1022
Country	:	US
Telephone Number	:	541-475-4456
Fax Number	:	541-475-0132

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/08/2021
Last Update Date	:	02/08/2021

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Directions to “ NATALIE CHAVEZ ” Practice Location

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