Provider Demographics
NPI:1902638398
Name:CHAVEZ, ROSALINDA
Entity type:Individual
Prefix:
First Name:ROSALINDA
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 1:3400 W 16TH ST STE P
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-6871
Mailing Address - Country:US
Mailing Address - Phone:970-405-4042
Mailing Address - Fax:
Practice Address - Street 1:3400 W 16TH ST STE P
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-6871
Practice Address - Country:US
Practice Address - Phone:970-978-4386
Practice Address - Fax:970-888-3175
Is Sole Proprietor?:No
Enumeration Date:2024-08-15
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPN0027166164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse