Healthcare Provider Details

I. General information

NPI: 1457988453
Provider Name (Legal Business Name): CHELSEA RUNEZ BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CHELSEA NICOLE RUNEZ

II. Dates (important events)

Enumeration Date: 03/27/2020
Last Update Date: 03/27/2020
Certification Date: 03/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 E TAMPA ST
SPRINGFIELD MO
65806-1131
US

IV. Provider business mailing address

380 W 22ND ST APT 508
KANSAS CITY MO
64108-2073
US

V. Phone/Fax

Practice location:
  • Phone: 417-831-0150
  • Fax:
Mailing address:
  • Phone: 816-244-4863
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: