Provider Demographics
NPI:1497905152
Name:NELSON, CHANTEL LOUISE (LMP, ACSM)
Entity Type:Individual
Prefix:
First Name:CHANTEL
Middle Name:LOUISE
Last Name:NELSON
Suffix:
Gender:F
Credentials:LMP, ACSM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 968
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:WA
Mailing Address - Zip Code:98595-0968
Mailing Address - Country:US
Mailing Address - Phone:360-500-9970
Mailing Address - Fax:
Practice Address - Street 1:722 N MONTESANO STREET
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:WA
Practice Address - Zip Code:98595
Practice Address - Country:US
Practice Address - Phone:360-500-9970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-30
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00016401174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist