Provider Demographics
NPI:1790360600
Name:CHAVEZ, KATHERINE PAOLA (FNP)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:PAOLA
Last Name:CHAVEZ
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12-18 LINCOLN PL APT 3
Mailing Address - Street 2:
Mailing Address - City:OSSINING
Mailing Address - State:NY
Mailing Address - Zip Code:10562-5242
Mailing Address - Country:US
Mailing Address - Phone:914-434-0322
Mailing Address - Fax:
Practice Address - Street 1:7-11 S BROADWAY
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10601-3531
Practice Address - Country:US
Practice Address - Phone:914-723-4900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-11
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF347410363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily