Provider Demographics
NPI:1710655659
Name:CHAVEZ, AISHA MICHELLE
Entity Type:Individual
Prefix:
First Name:AISHA
Middle Name:MICHELLE
Last Name:CHAVEZ
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 1:1949 N SWAN RD UNIT 8
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-2759
Mailing Address - Country:US
Mailing Address - Phone:520-248-6622
Mailing Address - Fax:
Practice Address - Street 1:1949 N SWAN RD UNIT 8
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2759
Practice Address - Country:US
Practice Address - Phone:520-248-6622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-04
Last Update Date:2021-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ242321163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse