Provider Demographics
NPI:1780187658
Name:DEROCHA-CAVALEA, CHELSEA RAE (APNP)
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:RAE
Last Name:DEROCHA-CAVALEA
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2514 S 102ND ST STE 120
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53227-2142
Mailing Address - Country:US
Mailing Address - Phone:414-259-8917
Mailing Address - Fax:414-777-5210
Practice Address - Street 1:601 N 99TH ST STE 302
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-4362
Practice Address - Country:US
Practice Address - Phone:414-431-2186
Practice Address - Fax:414-431-9619
Is Sole Proprietor?:No
Enumeration Date:2018-03-16
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8293363L00000X
WI8293-033363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100075795Medicaid