Healthcare Provider Details

I. General information

NPI: 1194164475
Provider Name (Legal Business Name): CHELSEA JO DRAKE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2013
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1715 61ST AVE
GREELEY CO
80634-7989
US

IV. Provider business mailing address

1715 61ST AVE
GREELEY CO
80634-7989
US

V. Phone/Fax

Practice location:
  • Phone: 970-336-1500
  • Fax: 970-336-1505
Mailing address:
  • Phone: 970-336-1500
  • Fax: 970-336-1505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberR74095
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberDR0058576
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: