Provider Demographics
NPI:1194090951
Name:CHAVEZ, MARCIE
Entity type:Individual
Prefix:
First Name:MARCIE
Middle Name:
Last Name:CHAVEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 S WERNER ST
Mailing Address - Street 2:
Mailing Address - City:ADAMS
Mailing Address - State:WI
Mailing Address - Zip Code:53910-9348
Mailing Address - Country:US
Mailing Address - Phone:608-548-4958
Mailing Address - Fax:
Practice Address - Street 1:200 S WERNER ST
Practice Address - Street 2:
Practice Address - City:ADAMS
Practice Address - State:WI
Practice Address - Zip Code:53910-9348
Practice Address - Country:US
Practice Address - Phone:608-548-4958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-13
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI176617-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse