Healthcare Provider Details

I. General information

NPI: 1518797034
Provider Name (Legal Business Name): CHELSEA AUTUMN SENTICH NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2024
Last Update Date: 04/30/2025
Certification Date: 04/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 6244
WHEELING WV
26003-0722
US

IV. Provider business mailing address

3183 COUNTY ROAD 8
DILLONVALE OH
43917-7965
US

V. Phone/Fax

Practice location:
  • Phone: 304-843-5041
  • Fax:
Mailing address:
  • Phone: 740-433-9210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.0037126
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: