Provider Demographics
NPI:1275517484
Name:CHELOTTI, JUDITH A (ARNP)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:A
Last Name:CHELOTTI
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:JUDITH
Other - Middle Name:A
Other - Last Name:HORSHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:1901 S CEDAR
Mailing Address - Street 2:#301 CARDIAC STUDY CENTER INC PS
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405
Mailing Address - Country:US
Mailing Address - Phone:253-572-7320
Mailing Address - Fax:253-627-3191
Practice Address - Street 1:1901 S CEDAR
Practice Address - Street 2:#301 CARDIAC STUDY CENTER INC PS
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405
Practice Address - Country:US
Practice Address - Phone:253-572-7320
Practice Address - Fax:253-627-3191
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30003769363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9636705Medicaid
WA8808191Medicare ID - Type Unspecified
WA9636705Medicaid