Provider Demographics
NPI:1265840177
Name:MARLENE A. CHELSO, APRN
Entity Type:Organization
Organization Name:MARLENE A. CHELSO, APRN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARLENE
Authorized Official - Middle Name:A
Authorized Official - Last Name:CHELSO
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:203-775-9484
Mailing Address - Street 1:127 TOWER RD
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06804-3654
Mailing Address - Country:US
Mailing Address - Phone:203-775-9484
Mailing Address - Fax:
Practice Address - Street 1:127 TOWER RD
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:CT
Practice Address - Zip Code:06804-3654
Practice Address - Country:US
Practice Address - Phone:203-775-9484
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-24
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001752164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty