Provider Demographics
NPI:1376204073
Name:CHAVIRA, DIANA (RN)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:CHAVIRA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5025 WINCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79762-4434
Mailing Address - Country:US
Mailing Address - Phone:432-703-7798
Mailing Address - Fax:
Practice Address - Street 1:1216 E 8TH ST
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-4638
Practice Address - Country:US
Practice Address - Phone:432-888-9806
Practice Address - Fax:432-888-9777
Is Sole Proprietor?:No
Enumeration Date:2022-01-04
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1056522163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1056522OtherRN LICENSE