Provider Demographics
NPI:1508509530
Name:CHAVEZ, AMY (APRN CPNP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:CHAVEZ
Suffix:
Gender:F
Credentials:APRN CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3412 S 25TH E
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-4967
Mailing Address - Country:US
Mailing Address - Phone:208-710-9200
Mailing Address - Fax:
Practice Address - Street 1:3412 S 25TH E
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-4967
Practice Address - Country:US
Practice Address - Phone:208-497-0680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-18
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID69247363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics