Provider Demographics
NPI:1407335383
Name:GALIPEAU, CHELSEY (PA-C)
Entity Type:Individual
Prefix:
First Name:CHELSEY
Middle Name:
Last Name:GALIPEAU
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2450 E GALA ST
Mailing Address - Street 2:STE 100
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-4805
Mailing Address - Country:US
Mailing Address - Phone:208-908-4541
Mailing Address - Fax:208-908-4542
Practice Address - Street 1:516 1ST AVE SW
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:ND
Practice Address - Zip Code:58601-5906
Practice Address - Country:US
Practice Address - Phone:701-260-1006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-10
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPA-1696363AM0700X
WI390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty