Provider Demographics
NPI:1285134833
Name:CHAVEZ, PRISCILLA (RN)
Entity type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:
Last Name:CHAVEZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3203 ACOMA TRL APT 3437
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76177-6226
Mailing Address - Country:US
Mailing Address - Phone:940-229-1801
Mailing Address - Fax:
Practice Address - Street 1:3203 ACOMA TRL APT 3437
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76177-6226
Practice Address - Country:US
Practice Address - Phone:940-229-1801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-20
Last Update Date:2018-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX853897163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse