MEDICARE: CHAMILLE ANGELA ELDER NP-C

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	363LA2200X	Adult Health Nurse Practitioner	COA.12730-NP	OH
2	363L00000X	Nurse Practitioner	COA.12730-NP	OH

General Provider Information

NPI Number	:	1760750962
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHAMILLE ANGELA ELDER NP-C

Provider Business Mailing Address
First Line	:	3515 MASSILLON RD
Second Line	:	STE 250
City	:	UNIONTOWN
State	:	OH
Zip	:	44685-6400
Country	:	US
Telephone Number	:	330-896-5651
Fax Number	:	330-896-5685

Provider Business Practice Location Address
First Line	:	3515 MASSILLON RD
Second Line	:	STE 250
City	:	UNIONTOWN
State	:	OH
Zip	:	44685-6400
Country	:	US
Telephone Number	:	330-896-5651
Fax Number	:	330-896-5685

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

Provider Enumeration Date	:	12/02/2011
Last Update Date	:	11/28/2016

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