Healthcare Provider Details

I. General information

NPI: 1780755769
Provider Name (Legal Business Name): MARLENE A CHELSO APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARLENE A CHELSO APRN

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 11/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 COOPER PLZ RM 307
CAMDEN NJ
08103-1438
US

IV. Provider business mailing address

1 FEDERAL ST STE SW200
CAMDEN NJ
08103-1155
US

V. Phone/Fax

Practice location:
  • Phone: 856-342-2328
  • Fax: 856-541-6137
Mailing address:
  • Phone: 856-356-4924
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number001752
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number001752
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number001752
License Number StateCT
# 4
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NJ00845100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: