Healthcare Provider Details

I. General information

NPI: 1972008662
Provider Name (Legal Business Name): CHELSIA DANIELLE DERENARD CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2018
Last Update Date: 03/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1480 CENTER RD
AVON OH
44011-1239
US

IV. Provider business mailing address

237 BUTTERNUT LN
BEREA OH
44017-1359
US

V. Phone/Fax

Practice location:
  • Phone: 440-937-4600
  • Fax:
Mailing address:
  • Phone: 330-323-2098
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.022549
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: