Provider Demographics
NPI:1750530705
Name:CHAVEZ, PEGGY J (MSN, RN)
Entity type:Individual
Prefix:
First Name:PEGGY
Middle Name:J
Last Name:CHAVEZ
Suffix:
Gender:F
Credentials:MSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BELEN
Mailing Address - State:NM
Mailing Address - Zip Code:87002-3720
Mailing Address - Country:US
Mailing Address - Phone:505-966-1105
Mailing Address - Fax:505-966-1065
Practice Address - Street 1:1619 W DELGADO AVE
Practice Address - Street 2:
Practice Address - City:BELEN
Practice Address - State:NM
Practice Address - Zip Code:87002-2805
Practice Address - Country:US
Practice Address - Phone:505-966-1861
Practice Address - Fax:505-966-1865
Is Sole Proprietor?:No
Enumeration Date:2008-09-15
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR36240163W00000X, 163WA2000X, 163WP0808X, 163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No163WS0200XNursing Service ProvidersRegistered NurseSchool