Provider Demographics
NPI:1891955902
Name:CHAVIS, NICHELLE TRINETTE
Entity Type:Individual
Prefix:MS
First Name:NICHELLE
Middle Name:TRINETTE
Last Name:CHAVIS
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 1:13923 E EXPOSITION AVE
Mailing Address - Street 2:2
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-2521
Mailing Address - Country:US
Mailing Address - Phone:303-344-1383
Mailing Address - Fax:
Practice Address - Street 1:13923 E EXPOSITION AVE
Practice Address - Street 2:2
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-2521
Practice Address - Country:US
Practice Address - Phone:303-344-1383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-11
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO42380111744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management