Provider Demographics
NPI:1780193656
Name:CHAVEZ, CIELO (ARNP)
Entity Type:Individual
Prefix:
First Name:CIELO
Middle Name:
Last Name:CHAVEZ
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4033 TALBOT RD S STE 350
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-5767
Mailing Address - Country:US
Mailing Address - Phone:425-690-3498
Mailing Address - Fax:425-690-9498
Practice Address - Street 1:4033 TALBOT RD S STE 350
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-5767
Practice Address - Country:US
Practice Address - Phone:425-690-3498
Practice Address - Fax:425-690-9498
Is Sole Proprietor?:No
Enumeration Date:2017-09-23
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN61284655163W00000X
FLAPRN9303874363L00000X
FLARNP9303874363LP2300X
WAAP61477594363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care