Provider Demographics
NPI:1013455518
Name:CHE, VIVIANE
Entity Type:Individual
Prefix:
First Name:VIVIANE
Middle Name:
Last Name:CHE
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:PO BOX 35380
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89133-5380
Mailing Address - Country:US
Mailing Address - Phone:702-838-8265
Mailing Address - Fax:
Practice Address - Street 1:20040 N 19TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-4255
Practice Address - Country:US
Practice Address - Phone:602-249-0115
Practice Address - Fax:602-249-0838
Is Sole Proprietor?:No
Enumeration Date:2017-02-03
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209015522363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care