Provider Demographics
NPI:1124334685
Name:CHARDAVOYNE, ALEXIS CRISTINE (PNP-BC)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:CRISTINE
Last Name:CHARDAVOYNE
Suffix:
Gender:F
Credentials:PNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13123 E 16TH AVE # B140
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80045-7106
Mailing Address - Country:US
Mailing Address - Phone:720-777-6895
Mailing Address - Fax:720-777-7285
Practice Address - Street 1:13123 E 16TH AVE # B140
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045-7106
Practice Address - Country:US
Practice Address - Phone:720-777-6895
Practice Address - Fax:720-777-7285
Is Sole Proprietor?:No
Enumeration Date:2010-08-23
Last Update Date:2013-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO175782363LP0200X
CT004625363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004236346Medicaid