Provider Demographics
NPI:1518938976
Name:KAVGAZOFF, CHANTAL (APRN)
Entity Type:Individual
Prefix:
First Name:CHANTAL
Middle Name:
Last Name:KAVGAZOFF
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 15645
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89114-5645
Mailing Address - Country:US
Mailing Address - Phone:702-877-8690
Mailing Address - Fax:702-877-5341
Practice Address - Street 1:888 S RANCHO
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106
Practice Address - Country:US
Practice Address - Phone:702-877-8690
Practice Address - Fax:702-877-5341
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2014-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPN00457363LX0001X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV2402366Medicaid
NV3102666Medicaid
NV3102666Medicaid
P18025Medicare UPIN
NV33995Medicare PIN