Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0129X | Vascular Surgeon | 5013295 | NC |
N | 208G00000X | Cardiothoracic Vascular Surgeon | 5013295 | NC |
Y | 363L00000X | Nurse Practitioner | 5013295 | NC |
N | 363LA2100X | Nurse Practitioner - Acute Care | 5013295 | NC |
N | 363LA2200X | Nurse Practitioner - Adult Health | 5013295 | NC |
N | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 5013295 | NC |
N | 363LG0600X | Nurse Practitioner - Gerontology | 5013295 | NC |
NPI | 1336767185 |
---|---|
Provider Name | Teena Ruby Chavis |
First Address | Raleigh, NC 27610-1231 |
Second Address | Raleigh, NC 27610-1231 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2020 |
Last Update Date | 03/08/2020 |