Provider Demographics
NPI:1629482161
Name:MCNUTT, CHELSEA LEE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:CHELSEA
Middle Name:LEE
Last Name:MCNUTT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:CHELSEA
Other - Middle Name:LEE
Other - Last Name:MORTIMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:100 HOSPITAL AVE
Mailing Address - Street 2:
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-1440
Mailing Address - Country:US
Mailing Address - Phone:814-375-4200
Mailing Address - Fax:814-375-4232
Practice Address - Street 1:145 HOSPITAL AVE
Practice Address - Street 2:SUITE 215
Practice Address - City:DU BOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-1462
Practice Address - Country:US
Practice Address - Phone:814-375-1717
Practice Address - Fax:814-375-4422
Is Sole Proprietor?:No
Enumeration Date:2014-06-12
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOA003299363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA360868T0YMedicare PIN