Healthcare Provider Details

I. General information

NPI: 1720634496
Provider Name (Legal Business Name): CHELSIE NICOLE LISLE CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHELSIE BUCHHOLZ CRNA

II. Dates (important events)

Enumeration Date: 08/17/2019
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3821 SPRING ST
MOUNT PLEASANT WI
53405-1667
US

IV. Provider business mailing address

5121 EICHELBERGER ST
SAINT LOUIS MO
63109-3236
US

V. Phone/Fax

Practice location:
  • Phone: 262-687-4011
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number2017013613
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberD187768
License Number StateIA
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number7970
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number2017013613
License Number StateMO
# 5
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number10247
License Number StateIL
# 6
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number10247-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: