Healthcare Provider Details

I. General information

NPI: 1851767164
Provider Name (Legal Business Name): JEAN CHELICH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2015
Last Update Date: 08/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 WILLIAM ST
SPRINGFIELD MA
01105-2324
US

IV. Provider business mailing address

136 WILLIAM ST
SPRINGFIELD MA
01105-2324
US

V. Phone/Fax

Practice location:
  • Phone: 800-218-9280
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number041.309175
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: