Healthcare Provider Details

I. General information

NPI: 1326818733
Provider Name (Legal Business Name): CHELSEY CHESHIRE FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2024
Last Update Date: 01/05/2024
Certification Date: 01/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 MCMAHON BLVD NW STE 101
ALBUQUERQUE NM
87114-5090
US

IV. Provider business mailing address

8319 CALLE ADOLANTO NE
ALBUQUERQUE NM
87113-1770
US

V. Phone/Fax

Practice location:
  • Phone: 505-893-2840
  • Fax:
Mailing address:
  • Phone: 505-720-5402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number77262
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: