Provider Demographics
NPI:1568900637
Name:CHAVEZ, MONICA (RN)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:CHAVEZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:MONICA
Other - Middle Name:
Other - Last Name:CHAVEZ-SANTOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 7554
Mailing Address - Street 2:
Mailing Address - City:BONNEY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98391-0951
Mailing Address - Country:US
Mailing Address - Phone:559-862-7425
Mailing Address - Fax:
Practice Address - Street 1:9040 JACKSON AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98431-1100
Practice Address - Country:US
Practice Address - Phone:253-968-3869
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-08
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60559884163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse