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General NPI Number Information
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NPI Number | 1407642614
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Entity Type | Individual
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Provider Name | CHELSEA LYNN GAUTHIER
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Gender | Female
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Dates
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Enumeration Date | 04/15/2025
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Last Update Date | 04/15/2025
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Provider Practice Location Address
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Address Line | 3736 EUBANK BLVD NE STE B1
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City | ALBUQUERQUE
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State | NM
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Zip | 87111-3583
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Country | US
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Telephone | 505-293-2881
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Fax |
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Provider Business Mailing Address
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Address Line | 1375 CALLE DEL ORO
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City | BOSQUE FARMS
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State | NM
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Zip | 87068-9795
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Country | US
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Telephone | 505-917-1213
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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