Provider Demographics
NPI:1588057178
Name:CHAVOLLA, DANA MICHELLE (NP)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:MICHELLE
Last Name:CHAVOLLA
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 1:845 N 10TH ST STE 3
Mailing Address - Street 2:
Mailing Address - City:SANTA PAULA
Mailing Address - State:CA
Mailing Address - Zip Code:93060-1348
Mailing Address - Country:US
Mailing Address - Phone:805-525-0215
Mailing Address - Fax:805-921-1592
Practice Address - Street 1:845 N 10TH ST STE 3
Practice Address - Street 2:
Practice Address - City:SANTA PAULA
Practice Address - State:CA
Practice Address - Zip Code:93060-1348
Practice Address - Country:US
Practice Address - Phone:805-525-0215
Practice Address - Fax:805-921-1592
Is Sole Proprietor?:No
Enumeration Date:2015-03-06
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95002095363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily