Provider Demographics
NPI:1760750962
Name:ELDER, CHAMILLE ANGELA (NP-C)
Entity Type:Individual
Prefix:
First Name:CHAMILLE
Middle Name:ANGELA
Last Name:ELDER
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3515 MASSILLON RD
Mailing Address - Street 2:STE 250
Mailing Address - City:UNIONTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44685-6400
Mailing Address - Country:US
Mailing Address - Phone:330-896-5651
Mailing Address - Fax:330-896-5685
Practice Address - Street 1:3515 MASSILLON RD
Practice Address - Street 2:STE 250
Practice Address - City:UNIONTOWN
Practice Address - State:OH
Practice Address - Zip Code:44685-6400
Practice Address - Country:US
Practice Address - Phone:330-896-5651
Practice Address - Fax:330-896-5685
Is Sole Proprietor?:No
Enumeration Date:2011-12-02
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.12730-NP363LA2200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health