Healthcare Provider Details

I. General information

NPI: 1548792138
Provider Name (Legal Business Name): CHELSEA B FARRELL CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHELSEA B MOYER CRNA

II. Dates (important events)

Enumeration Date: 04/01/2017
Last Update Date: 10/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3535 SOUTHERN BLVD
KETTERING OH
45429-1221
US

IV. Provider business mailing address

PO BOX 932759
CLEVELAND OH
44193-0015
US

V. Phone/Fax

Practice location:
  • Phone: 937-293-8228
  • Fax: 937-293-8229
Mailing address:
  • Phone: 866-282-7905
  • Fax: 800-731-0751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.371694
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN.CRNA.019561
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: