Healthcare Provider Details

I. General information

NPI: 1043785991
Provider Name (Legal Business Name): CHELSEA FELIX RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHELSEA UCHENNA CHULEUERLOLUE

II. Dates (important events)

Enumeration Date: 10/08/2018
Last Update Date: 10/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

167 POLK ST STE 300
WATERTOWN NY
13601-2770
US

IV. Provider business mailing address

PO BOX 6550
WATERTOWN NY
13601-6550
US

V. Phone/Fax

Practice location:
  • Phone: 315-782-7445
  • Fax: 315-779-1184
Mailing address:
  • Phone: 315-782-7445
  • Fax: 315-779-1184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number759028
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: