Provider Demographics
NPI:1407299837
Name:CHAVEZ, NICHOLE ANN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:NICHOLE
Middle Name:ANN
Last Name:CHAVEZ
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19740 W HILTON AVE
Mailing Address - Street 2:
Mailing Address - City:BUCKEYE
Mailing Address - State:AZ
Mailing Address - Zip Code:85326-9034
Mailing Address - Country:US
Mailing Address - Phone:623-547-1418
Mailing Address - Fax:
Practice Address - Street 1:5340 N. WIGWAM CREEK BLVD
Practice Address - Street 2:
Practice Address - City:LITCHFIELD PARK
Practice Address - State:AZ
Practice Address - Zip Code:85340-4930
Practice Address - Country:US
Practice Address - Phone:623-547-1418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-16
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLP045089164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse