Provider Demographics
NPI:1295884948
Name:BREECE, CHAVALIA J (NP)
Entity type:Individual
Prefix:
First Name:CHAVALIA
Middle Name:J
Last Name:BREECE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8503 ARLINGTON BLVD
Mailing Address - Street 2:#120
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4628
Mailing Address - Country:US
Mailing Address - Phone:703-573-3494
Mailing Address - Fax:703-537-5353
Practice Address - Street 1:8503 ARLINGTON BLVD
Practice Address - Street 2:#120
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4628
Practice Address - Country:US
Practice Address - Phone:703-573-3494
Practice Address - Fax:703-537-5353
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024164054363L00000X
DCNP48148363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC003773C42Medicare PIN
VA017037C55Medicare PIN
VAQ07760Medicare UPIN