Healthcare Provider Details

I. General information

NPI: 1336820166
Provider Name (Legal Business Name): CHELSEA DEKLE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2023
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 TOLL HOUSE AVE
FREDERICK MD
21701-5930
US

IV. Provider business mailing address

915 TOLL HOUSE AVE STE 307
FREDERICK MD
21701-5901
US

V. Phone/Fax

Practice location:
  • Phone: 301-732-6300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAC007530
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: