Healthcare Provider Details

I. General information

NPI: 1710898630
Provider Name (Legal Business Name): CHELSY EVANS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MRS. CHELSY GRABER

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4110 SOUTHWAY ST SW
MASSILLON OH
44646-9337
US

IV. Provider business mailing address

2551 MARY LOU ST NW
MASSILLON OH
44646-2733
US

V. Phone/Fax

Practice location:
  • Phone: 330-409-8600
  • Fax: 330-409-8690
Mailing address:
  • Phone: 330-265-5149
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.479478
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: