Provider Demographics
NPI:1316219520
Name:CHAVIES, LAURA (STNA)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:CHAVIES
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:RAISOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:STNA
Mailing Address - Street 1:3790 US HIGHWAY 50
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45176-6203
Mailing Address - Country:US
Mailing Address - Phone:513-628-1147
Mailing Address - Fax:
Practice Address - Street 1:3790 US HIGHWAY 50
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:OH
Practice Address - Zip Code:45176-6203
Practice Address - Country:US
Practice Address - Phone:513-628-1147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-02
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH376K00000X172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker