Healthcare Provider Details

I. General information

NPI: 1407642614
Provider Name (Legal Business Name): CHELSEA LYNN GAUTHIER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2025
Last Update Date: 04/15/2025
Certification Date: 04/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3736 EUBANK BLVD NE STE B1
ALBUQUERQUE NM
87111-3583
US

IV. Provider business mailing address

1375 CALLE DEL ORO
BOSQUE FARMS NM
87068-9795
US

V. Phone/Fax

Practice location:
  • Phone: 505-293-2881
  • Fax:
Mailing address:
  • Phone: 505-917-1213
  • 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: