Provider Demographics
NPI:1093232654
Name:CHESTERSON, DEONN MICHELLE (MSN, RN, FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:DEONN
Middle Name:MICHELLE
Last Name:CHESTERSON
Suffix:
Gender:F
Credentials:MSN, RN, FNP-BC
Other - Prefix:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 781076
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48278-1076
Mailing Address - Country:US
Mailing Address - Phone:317-528-4800
Mailing Address - Fax:317-865-1479
Practice Address - Street 1:1701 S CREASY LN
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-4972
Practice Address - Country:US
Practice Address - Phone:765-502-4917
Practice Address - Fax:765-502-4023
Is Sole Proprietor?:No
Enumeration Date:2017-08-24
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71007394A363LF0000X
IN28163944A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN28163944AOtherRN LICENSE
IN71007394AOtherAPN LICENSE