MEDICARE: CHELSEA ROSE O'NEILL FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	4704306690NSA190OI	MI

General Provider Information

NPI Number	:	1366078230
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHELSEA ROSE O'NEILL FNP

Provider Business Mailing Address
First Line	:	1655 N SHORE DR APT A2
Second Line	:
City	:	EAST LANSING
State	:	MI
Zip	:	48823-1785
Country	:	US
Telephone Number	:	248-251-2891
Fax Number	:

Provider Business Practice Location Address
First Line	:	1223 S WASHINGTON AVE
Second Line	:
City	:	ROYAL OAK
State	:	MI
Zip	:	48067-3221
Country	:	US
Telephone Number	:	248-439-1060
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2020
Last Update Date	:	03/23/2020

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