Provider Demographics
NPI:1679061394
Name:MILLER, CHELSEA BELLE (LPN)
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:BELLE
Last Name:MILLER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1511 INDIAN LAKES RD NE
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:MI
Mailing Address - Zip Code:49345-9590
Mailing Address - Country:US
Mailing Address - Phone:616-514-0073
Mailing Address - Fax:
Practice Address - Street 1:1511 INDIAN LAKES RD NE
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:MI
Practice Address - Zip Code:49345-9590
Practice Address - Country:US
Practice Address - Phone:616-514-0073
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-27
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703122651164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse