Provider Demographics
NPI:1588207013
Name:BENELL, CHELSEA NICOLE
Entity Type:Individual
Prefix:MRS
First Name:CHELSEA
Middle Name:NICOLE
Last Name:BENELL
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 1:33 DACOTAH AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:NJ
Mailing Address - Zip Code:07436-2112
Mailing Address - Country:US
Mailing Address - Phone:201-956-0542
Mailing Address - Fax:
Practice Address - Street 1:1 GARDEN STATE PLZ
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-2417
Practice Address - Country:US
Practice Address - Phone:201-956-0542
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-28
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00976400363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily