MEDICARE: CHANTEL S WILLMANN NP

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	363L00000X	Nurse Practitioner	71000712A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000001074962	OTHER	IN	ANTHEM
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467466854
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHANTEL S WILLMANN NP

Provider Business Mailing Address
First Line	:	1200 W WHITE RIVER BLVD
Second Line	:
City	:	MUNCIE
State	:	IN
Zip	:	47303-4988
Country	:	US
Telephone Number	:	877-668-5621
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 PILGRIM BLVD
Second Line	:
City	:	HARTFORD CITY
State	:	IN
Zip	:	47348-1382
Country	:	US
Telephone Number	:	765-348-5776
Fax Number	:	765-348-8335

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

Provider Enumeration Date	:	07/28/2006
Last Update Date	:	03/02/2021

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