Provider Demographics
NPI:1205810199
Name:CHAVES, ROBIN LAIRD (CRNA)
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:LAIRD
Last Name:CHAVES
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3939 QUILLING RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON-SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27104-1505
Mailing Address - Country:US
Mailing Address - Phone:336-768-0696
Mailing Address - Fax:
Practice Address - Street 1:MEDICAL CENTER BLVD.
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27157-0001
Practice Address - Country:US
Practice Address - Phone:336-716-3069
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-03
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC048625367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
8051096Medicare PIN