Provider Demographics
NPI:1568048676
Name:PENDLETON EL, DECHELL (CPE)
Entity Type:Individual
Prefix:
First Name:DECHELL
Middle Name:
Last Name:PENDLETON EL
Suffix:
Gender:F
Credentials:CPE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:788 TUSCARORA AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102-3908
Mailing Address - Country:US
Mailing Address - Phone:612-991-0647
Mailing Address - Fax:
Practice Address - Street 1:115 ELM ST STE 1
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55024-1033
Practice Address - Country:US
Practice Address - Phone:612-221-1149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-19
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula