Provider Demographics
NPI:1578907861
Name:CHADWELL, KATHERINE
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:
Last Name:CHADWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10700 SW 30TH PL
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33328-1536
Mailing Address - Country:US
Mailing Address - Phone:954-452-1861
Mailing Address - Fax:
Practice Address - Street 1:10700 SW 30TH PL
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33328-1536
Practice Address - Country:US
Practice Address - Phone:954-452-1861
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-17
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1164452363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology