Provider Demographics
NPI:1467466854
Name:WILLMANN, CHANTEL S (NP)
Entity Type:Individual
Prefix:
First Name:CHANTEL
Middle Name:S
Last Name:WILLMANN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 W WHITE RIVER BLVD
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47303-4988
Mailing Address - Country:US
Mailing Address - Phone:877-668-5621
Mailing Address - Fax:
Practice Address - Street 1:400 PILGRIM BLVD
Practice Address - Street 2:
Practice Address - City:HARTFORD CITY
Practice Address - State:IN
Practice Address - Zip Code:47348-1382
Practice Address - Country:US
Practice Address - Phone:765-348-5776
Practice Address - Fax:765-348-8335
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71000712A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000001074962OtherANTHEM
IN200236100Medicaid
IN000001074962OtherANTHEM
IN234760IMedicare PIN