Individual
BERTHA CHAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
150 AVENUE U NW # C, WINTER HAVEN, FL 33881-2156
(407) 927-1980
Mailing address
150 AVENUE U NW # C, WINTER HAVEN, FL 33881-2156
(407) 927-1980
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN1322231
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
686492979
—
FL
Enumeration date
06/24/2012
Last updated
06/24/2012
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