Provider Demographics
NPI:1053903393
Name:CHAVEZ, NATALIE
Entity type:Individual
Prefix:
First Name:NATALIE
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 1:715 SW 4TH ST STE C
Mailing Address - Street 2:
Mailing Address - City:MADRAS
Mailing Address - State:OR
Mailing Address - Zip Code:97741-1022
Mailing Address - Country:US
Mailing Address - Phone:541-475-4456
Mailing Address - Fax:541-475-0132
Practice Address - Street 1:715 SW 4TH ST STE C
Practice Address - Street 2:
Practice Address - City:MADRAS
Practice Address - State:OR
Practice Address - Zip Code:97741-1022
Practice Address - Country:US
Practice Address - Phone:541-475-4456
Practice Address - Fax:541-475-0132
Is Sole Proprietor?:No
Enumeration Date:2021-02-08
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORTHW000104050172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker