Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086X0206X | Surgical Oncologist | 67493 | WI |
Y | 2086X0206X | Surgical Oncologist | MD58628 | TN |
NPI | 1265787550 |
---|---|
Provider Name | Mariana Isabel Chavez |
First Address | Nashville, TN 37214-3693 |
Second Address | Nashville, TN 37203 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/07/2012 |
Last Update Date | 14/05/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1265787550 | (05) | WI |