Provider Demographics
NPI:1821341975
Name:CHATELAIN, ALYSON (APRN)
Entity Type:Individual
Prefix:
First Name:ALYSON
Middle Name:
Last Name:CHATELAIN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 AUTUMN CHERRY WAY
Mailing Address - Street 2:
Mailing Address - City:KAYSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84037-5007
Mailing Address - Country:US
Mailing Address - Phone:801-791-0458
Mailing Address - Fax:
Practice Address - Street 1:322 AUTUMN CHERRY WAY
Practice Address - Street 2:
Practice Address - City:KAYSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84037-5007
Practice Address - Country:US
Practice Address - Phone:801-791-0458
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-25
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT378509-4405363L00000X, 363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal