=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225546070
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHELSEY MILLER APRN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/15/2018
-----------------------------------------------------
Last Update Date | 06/18/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 601 W SPRUCE ST STE J
-----------------------------------------------------
City | MISSOULA
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59802-4047
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-327-3350
-----------------------------------------------------
Fax | 406-327-3355
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 500 W BROADWAY ST
-----------------------------------------------------
City | MISSOULA
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59802-4008
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-327-1918
-----------------------------------------------------
Fax | 406-549-2246
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | NUR-APRN-LIC-128752
-----------------------------------------------------
License Number State | MT
-----------------------------------------------------