Provider Demographics
NPI:1508268491
Name:REICH, CHELSEA A (PA-C)
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:A
Last Name:REICH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CHELSEA
Other - Middle Name:A
Other - Last Name:VAN DYKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:400 E THIRD STREET
Mailing Address - Street 2:
Mailing Address - City:DU
Mailing Address - State:MN
Mailing Address - Zip Code:55805-1951
Mailing Address - Country:US
Mailing Address - Phone:218-828-7548
Mailing Address - Fax:
Practice Address - Street 1:720 MAIN AVE
Practice Address - Street 2:
Practice Address - City:MOORHEAD
Practice Address - State:MN
Practice Address - Zip Code:56560
Practice Address - Country:US
Practice Address - Phone:218-359-0399
Practice Address - Fax:218-359-0096
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-23
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1012363A00000X
SD363A00000X
MN12887363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant