Healthcare Provider Details

I. General information

NPI: 1780383562
Provider Name (Legal Business Name): CHELSEA KAZMIERCZAK-GOETHEL MS, CNS, LN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2023
Last Update Date: 12/03/2024
Certification Date: 12/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3558 STINSON BLVD
MINNEAPOLIS MN
55418-1519
US

IV. Provider business mailing address

3558 STINSON BLVD
MINNEAPOLIS MN
55418-1519
US

V. Phone/Fax

Practice location:
  • Phone: 701-306-1123
  • Fax:
Mailing address:
  • Phone: 701-306-1123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number23
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: