Provider Demographics
NPI:1083497358
Name:CHRYSALIS WELLNESS, PLC
Entity Type:Organization
Organization Name:CHRYSALIS WELLNESS, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHANDRA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, CNP
Authorized Official - Phone:218-969-0386
Mailing Address - Street 1:14 PRESIDENT AVE # 701
Mailing Address - Street 2:
Mailing Address - City:BUHL
Mailing Address - State:MN
Mailing Address - Zip Code:55713-4451
Mailing Address - Country:US
Mailing Address - Phone:218-969-0386
Mailing Address - Fax:
Practice Address - Street 1:302 CHESTNUT ST STE 408
Practice Address - Street 2:
Practice Address - City:VIRGINIA
Practice Address - State:MN
Practice Address - Zip Code:55792-5610
Practice Address - Country:US
Practice Address - Phone:218-969-7824
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-18
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty