Provider Demographics
NPI:1457824260
Name:CHAVEZ, GERALDINE (LPN)
Entity Type:Individual
Prefix:
First Name:GERALDINE
Middle Name:
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 1:112 MONROE ST NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87108-1247
Mailing Address - Country:US
Mailing Address - Phone:505-260-9917
Mailing Address - Fax:505-260-0754
Practice Address - Street 1:112 MONROE ST NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-1247
Practice Address - Country:US
Practice Address - Phone:505-260-9917
Practice Address - Fax:505-260-0754
Is Sole Proprietor?:No
Enumeration Date:2019-01-03
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NML05647164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse