Provider Demographics
NPI:1063394245
Name:CHAVARRIA, CATHY A
Entity type:Individual
Prefix:
First Name:CATHY
Middle Name:A
Last Name:CHAVARRIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 F ST S APT 3S
Mailing Address - Street 2:
Mailing Address - City:GLEN ULLIN
Mailing Address - State:ND
Mailing Address - Zip Code:58631-7119
Mailing Address - Country:US
Mailing Address - Phone:720-351-1886
Mailing Address - Fax:
Practice Address - Street 1:101 F ST S APT 3
Practice Address - Street 2:
Practice Address - City:GLEN ULLIN
Practice Address - State:ND
Practice Address - Zip Code:58631-7119
Practice Address - Country:US
Practice Address - Phone:720-351-1886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-21
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND715713747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant