Provider Demographics
NPI:1477207660
Name:CHANSLOR, NOELLE DIONE
Entity Type:Individual
Prefix:
First Name:NOELLE
Middle Name:DIONE
Last Name:CHANSLOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9205 BROOK ST
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55810-1526
Mailing Address - Country:US
Mailing Address - Phone:218-348-0254
Mailing Address - Fax:
Practice Address - Street 1:9205 BROOK ST
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55810-1526
Practice Address - Country:US
Practice Address - Phone:218-348-0254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-07
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1110435174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty