Provider Demographics
NPI:1780230318
Name:CHAVANDO, FELICIA RENEE (CPM, RM)
Entity Type:Individual
Prefix:
First Name:FELICIA
Middle Name:RENEE
Last Name:CHAVANDO
Suffix:
Gender:F
Credentials:CPM, RM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4089 UTE HWY
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80503-9126
Mailing Address - Country:US
Mailing Address - Phone:915-920-9613
Mailing Address - Fax:
Practice Address - Street 1:4089 UTE HWY
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80503-9126
Practice Address - Country:US
Practice Address - Phone:915-920-9613
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-09
Last Update Date:2019-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0000186176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty