Provider Demographics
NPI:1063912814
Name:CHAVEZ, DENNIS (FNP)
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:
Last Name:CHAVEZ
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39640 N KENNEDY DR
Mailing Address - Street 2:
Mailing Address - City:SAN TAN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85140-8850
Mailing Address - Country:US
Mailing Address - Phone:505-550-4601
Mailing Address - Fax:
Practice Address - Street 1:261 N ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85226-2616
Practice Address - Country:US
Practice Address - Phone:480-305-2888
Practice Address - Fax:480-305-2889
Is Sole Proprietor?:No
Enumeration Date:2018-02-19
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP10898363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily