Healthcare Provider Details

I. General information

NPI: 1407491699
Provider Name (Legal Business Name): KELSI S BELCHER CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2019
Last Update Date: 11/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 RALSTON AVE
DEFIANCE OH
43512-1396
US

IV. Provider business mailing address

1 SEAGATE STE 800
TOLEDO OH
43604-1558
US

V. Phone/Fax

Practice location:
  • Phone: 419-783-6944
  • Fax: 419-783-4416
Mailing address:
  • Phone: 567-585-1964
  • Fax: 419-824-7359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN.375868
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: