Provider Demographics
NPI:1316703564
Name:CHACON, ELLEN ARRABAL (NP)
Entity type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:ARRABAL
Last Name:CHACON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1690 GEMINI DR
Mailing Address - Street 2:
Mailing Address - City:ELDERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21784-6225
Mailing Address - Country:US
Mailing Address - Phone:443-812-6109
Mailing Address - Fax:
Practice Address - Street 1:1645 LIBERTY RD STE 204
Practice Address - Street 2:
Practice Address - City:ELDERSBURG
Practice Address - State:MD
Practice Address - Zip Code:21784-6542
Practice Address - Country:US
Practice Address - Phone:410-795-7737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR184690363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care