Provider Demographics
NPI:1043313646
Name:CHAVERS, RUKIYA J (FNP C)
Entity type:Individual
Prefix:MRS
First Name:RUKIYA
Middle Name:J
Last Name:CHAVERS
Suffix:
Gender:F
Credentials:FNP C
Other - Prefix:
Other - First Name:RUKIYA
Other - Middle Name:J
Other - Last Name:SHELLS-CHAVERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP-C
Mailing Address - Street 1:4110 N 108TH AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85037-5772
Mailing Address - Country:US
Mailing Address - Phone:623-772-6999
Mailing Address - Fax:623-772-6444
Practice Address - Street 1:4110 N 108TH AVE STE 105
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-5772
Practice Address - Country:US
Practice Address - Phone:623-772-6999
Practice Address - Fax:623-772-6444
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN107738163W00000X
AZAP2349363L00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ235248Medicaid