Healthcare Provider Details

I. General information

NPI: 1053848192
Provider Name (Legal Business Name): CHELSEA MCNAIR HIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2017
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 MAIN ST STE 106
MENDOTA HEIGHTS MN
55118-3765
US

IV. Provider business mailing address

149 PLANTATION RIDGE DR STE 140
MOORESVILLE NC
28117-9175
US

V. Phone/Fax

Practice location:
  • Phone: 704-360-4788
  • Fax: 704-251-6746
Mailing address:
  • Phone: 704-360-4788
  • Fax: 704-251-6746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number2811
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: