Provider Demographics
NPI:1366597304
Name:CHAGOLY, ADRIENNE M (RN,CNS)
Entity type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:M
Last Name:CHAGOLY
Suffix:
Gender:F
Credentials:RN,CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1603 MEDICAL PARKWAY
Mailing Address - Street 2:SUITE 330
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-7900
Mailing Address - Country:US
Mailing Address - Phone:512-765-7806
Mailing Address - Fax:512-456-7039
Practice Address - Street 1:1221 W BEN WHITE BLVD STE 200B
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-7002
Practice Address - Country:US
Practice Address - Phone:512-443-8500
Practice Address - Fax:512-443-2805
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX690975364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health