Provider Demographics
NPI:1730131616
Name:CHASTEEN, NANCY B (DO)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:B
Last Name:CHASTEEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:921 E LLANO ESTACADO BLVD
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:NM
Mailing Address - Zip Code:88101-3807
Mailing Address - Country:US
Mailing Address - Phone:505-763-4335
Mailing Address - Fax:
Practice Address - Street 1:921 E LLANO ESTACADO BLVD
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88101-3807
Practice Address - Country:US
Practice Address - Phone:505-763-4335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH2298207PE0004X, 207Q00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX140191141Medicaid
TX140191139Medicaid
TX140191141Medicaid
TX8K4462Medicare PIN
TX8D5143Medicare ID - Type Unspecified