Healthcare Provider Details

I. General information

NPI: 1154016285
Provider Name (Legal Business Name): CHELSEY HUTCHISON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2023
Last Update Date: 04/05/2023
Certification Date: 04/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 OVERLAND AVE STE D
BURLEY ID
83318-2434
US

IV. Provider business mailing address

1600 OVERLAND AVE STE D
BURLEY ID
83318-2434
US

V. Phone/Fax

Practice location:
  • Phone: 208-261-2805
  • Fax:
Mailing address:
  • Phone: 208-261-2805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License Number71061
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: