MEDICARE: CHELSEA MYNYK CNM

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	363LW0102X	Women's Health Nurse Practitioner	CNM03900	CO
2	363LX0001X	Obstetrics & Gynecology Nurse Practitioner	CNM03900	CO
3	367A00000X	Advanced Practice Midwife	CNM03900	CO

General Provider Information

NPI Number	:	1649823170
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHELSEA MYNYK CNM

Provider Business Mailing Address
First Line	:	PO BOX 2073
Second Line	:
City	:	CASTLE ROCK
State	:	CO
Zip	:	80104-1509
Country	:	US
Telephone Number	:	720-432-6580
Fax Number	:	720-496-0621

Provider Business Practice Location Address
First Line	:	1951 CHARBRAY PT
Second Line	:
City	:	CASTLE ROCK
State	:	CO
Zip	:	80108-8439
Country	:	US
Telephone Number	:	720-384-3254
Fax Number	:

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

Provider Enumeration Date	:	07/23/2019
Last Update Date	:	12/13/2021

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