Provider Demographics
NPI:1265150866
Name:CHAVEZ, NICOLE DYAN (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:DYAN
Last Name:CHAVEZ
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1031 N THOMAS ST
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:NM
Mailing Address - Zip Code:88220-4587
Mailing Address - Country:US
Mailing Address - Phone:575-941-2500
Mailing Address - Fax:575-941-2503
Practice Address - Street 1:1031 N THOMAS ST
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:NM
Practice Address - Zip Code:88220-4587
Practice Address - Country:US
Practice Address - Phone:575-941-4100
Practice Address - Fax:575-941-2503
Is Sole Proprietor?:No
Enumeration Date:2022-08-19
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM69419363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily