Provider Demographics
NPI:1982315529
Name:CHRYSALIS CHILDREN'S CLINIC, PLLC
Entity Type:Organization
Organization Name:CHRYSALIS CHILDREN'S CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PEDIATRIC NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:J
Authorized Official - Last Name:CABRERA
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:623-570-7829
Mailing Address - Street 1:6847 S ALDER DR
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-4148
Mailing Address - Country:US
Mailing Address - Phone:623-570-7829
Mailing Address - Fax:
Practice Address - Street 1:1845 E BROADWAY RD STE 116
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-1685
Practice Address - Country:US
Practice Address - Phone:602-851-5353
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-05
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Single Specialty