Healthcare Provider Details

I. General information

NPI: 1346603834
Provider Name (Legal Business Name): CHELSI YUKO HENNESSEY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2016
Last Update Date: 04/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2240 WINROW AVE UAS MEDDAC, RWBAHC
APO AA
85613
US

IV. Provider business mailing address

2240 WINROW RD
FORT HUACHUCA AZ
85613-5080
US

V. Phone/Fax

Practice location:
  • Phone: 520-533-2490
  • Fax:
Mailing address:
  • Phone: 520-533-2490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License NumberNURR31884
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: