Provider Demographics
NPI:1114591104
Name:CHELLE HEALTH LLC
Entity Type:Organization
Organization Name:CHELLE HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:WATERS
Authorized Official - Suffix:
Authorized Official - Credentials:NP-C
Authorized Official - Phone:435-979-8627
Mailing Address - Street 1:48 S 2500 W STE 240
Mailing Address - Street 2:
Mailing Address - City:HURRICANE
Mailing Address - State:UT
Mailing Address - Zip Code:84737-3382
Mailing Address - Country:US
Mailing Address - Phone:435-979-8627
Mailing Address - Fax:
Practice Address - Street 1:48 S 2500 W STE 240
Practice Address - Street 2:
Practice Address - City:HURRICANE
Practice Address - State:UT
Practice Address - Zip Code:84737-3382
Practice Address - Country:US
Practice Address - Phone:435-979-8627
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-14
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty