Provider Demographics
NPI:1669359832
Name:CHAVEZ, MARIELLE KARYNA (CPNP-AC)
Entity type:Individual
Prefix:
First Name:MARIELLE
Middle Name:KARYNA
Last Name:CHAVEZ
Suffix:
Gender:F
Credentials:CPNP-AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3124 RED MAPLE DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79938-4592
Mailing Address - Country:US
Mailing Address - Phone:915-228-8211
Mailing Address - Fax:
Practice Address - Street 1:1733 CURIE DR STE 103
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-2909
Practice Address - Country:US
Practice Address - Phone:915-532-2985
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-19
Last Update Date:2025-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1205200363LP0222X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0222XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics, Critical Care