Healthcare Provider Details

I. General information

NPI: 1134876733
Provider Name (Legal Business Name): CHELSEA M. KUHNERT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2022
Last Update Date: 03/04/2022
Certification Date: 03/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5383 STATE ROUTE 154
PINCKNEYVILLE IL
62274-3342
US

IV. Provider business mailing address

708 QUEENS WAY
PINCKNEYVILLE IL
62274-1909
US

V. Phone/Fax

Practice location:
  • Phone: 618-357-2187
  • Fax: 618-357-6247
Mailing address:
  • Phone: 618-357-2187
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209-024856
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: