Provider Demographics
NPI:1679533566
Name:CHAVEZ, JULIA R (CFNP)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:R
Last Name:CHAVEZ
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 OAK ST NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-4725
Mailing Address - Country:US
Mailing Address - Phone:505-855-5525
Mailing Address - Fax:505-884-4006
Practice Address - Street 1:300 OAK ST NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-4725
Practice Address - Country:US
Practice Address - Phone:505-855-5525
Practice Address - Fax:505-884-4006
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2011-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR28482363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM000Z5691Medicaid
NM201001679OtherPRESBYTERIAN
NM500019392OtherRAIL ROAD MEDICARE #
NM000H2506Medicaid
NMNM006395OtherBCBS/HMO NM #
NM000H2506Medicaid