Provider Demographics
NPI:1528513066
Name:CHAVEZ, ADAM (APRN, CNP)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:CHAVEZ
Suffix:
Gender:M
Credentials:APRN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:385 WIRTZ DR
Mailing Address - Street 2:
Mailing Address - City:DEKALB
Mailing Address - State:IL
Mailing Address - Zip Code:60115-3067
Mailing Address - Country:US
Mailing Address - Phone:815-306-2777
Mailing Address - Fax:815-306-2778
Practice Address - Street 1:385 WIRTZ DR
Practice Address - Street 2:
Practice Address - City:DEKALB
Practice Address - State:IL
Practice Address - Zip Code:60115-3067
Practice Address - Country:US
Practice Address - Phone:815-306-2777
Practice Address - Fax:815-306-2778
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-24
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID209014731363LF0000X
IL277000512363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily