MEDICARE: MRS. TARA K CHAVEZ RN

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	163WS0200X	School Registered Nurse	RN106452	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184724833
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TARA K CHAVEZ RN

Provider Business Mailing Address
First Line	:	4721 S PUEBLO AVE
Second Line	:
City	:	SIERRA VISTA
State	:	AZ
Zip	:	85650
Country	:	US
Telephone Number	:	520-803-0868
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 SCHOOL DR
Second Line	:	HUACHUCA CITY SCHOOL
City	:	HUACHUCA CITY
State	:	AZ
Zip	:	85616
Country	:	US
Telephone Number	:	520-456-9842
Fax Number	:	520-456-9811

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

Provider Enumeration Date	:	09/23/2006
Last Update Date	:	07/08/2007

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