Provider Demographics
NPI:1114447190
Name:JUAREZ-CHAVEZ, IVONNE ELIZABETH
Entity Type:Individual
Prefix:
First Name:IVONNE
Middle Name:ELIZABETH
Last Name:JUAREZ-CHAVEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 NOTT ST
Mailing Address - Street 2:
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-1623
Mailing Address - Country:US
Mailing Address - Phone:860-338-9477
Mailing Address - Fax:
Practice Address - Street 1:896 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-2912
Practice Address - Country:US
Practice Address - Phone:860-788-3632
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-21
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3883363A00000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant