Healthcare Provider Details

I. General information

NPI: 1871014662
Provider Name (Legal Business Name): CHELSIE ROSE PAGEL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2017
Last Update Date: 04/08/2020
Certification Date: 04/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

512 S 28TH AVE
WAUSAU WI
54401-4147
US

IV. Provider business mailing address

512 S 28TH AVE
WAUSAU WI
54401-4147
US

V. Phone/Fax

Practice location:
  • Phone: 715-847-2021
  • Fax:
Mailing address:
  • Phone: 715-847-2021
  • Fax: 715-847-2325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number4039
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: