1518272954 NPI number — CHELSAE MARIE VAN CALLIGAN

Table of content: CHELSAE MARIE VAN CALLIGAN (NPI 1518272954)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518272954 NPI number — CHELSAE MARIE VAN CALLIGAN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VAN CALLIGAN
Provider First Name:
CHELSAE
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KRONSER
Provider Other First Name:
CHELSAE
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1518272954
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/10/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8320 CITY CENTRE DR
Provider Second Line Business Mailing Address:
SUITE G.
Provider Business Mailing Address City Name:
WOODBURY
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55125-3382
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
651-738-9888
Provider Business Mailing Address Fax Number:
651-738-9889

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8320 CITY CENTRE DR
Provider Second Line Business Practice Location Address:
SUITE G.
Provider Business Practice Location Address City Name:
WOODBURY
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55125-3382
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-738-9888
Provider Business Practice Location Address Fax Number:
651-738-9889
Provider Enumeration Date:
08/10/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , with the licence number:  103946 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)