Doctor Name: | LADONNA LEE CHACON |
NPI Number: | 1326441346 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | AGPCNP-C |
License Number: | CNP-02602 |
Business Practice Address: | 1302 E Main St Tucumcari, NM - 884012508 |
Business Phone Number: | 5754612200 |
Business Fax Number: | 5754612213 |
Mailing Address: | 2799 Quay Road 64, TUCUMCARI |
State: | NM |
Postal Code: | 884019629 |
Phone Number: | 5755762708 |
Fax Number: | |
NPI Enumeration Date: | 10/04/2014 |
NPI Last Update Date: | 01/20/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LA2200X |
License Number: | CNP-02602 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | NM |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Adult Health |
Taxonomy Definition: |