Provider Demographics
NPI:1871848358
Name:JOSEPH, CHENELLE MAHALIA CHRYSTAL (MD)
Entity Type:Individual
Prefix:DR
First Name:CHENELLE
Middle Name:MAHALIA CHRYSTAL
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2401 DEMERS AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-4183
Mailing Address - Country:US
Mailing Address - Phone:701-780-4085
Mailing Address - Fax:701-780-4477
Practice Address - Street 1:1380 S COLUMBIA RD
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-4059
Practice Address - Country:US
Practice Address - Phone:701-795-2000
Practice Address - Fax:701-795-2260
Is Sole Proprietor?:No
Enumeration Date:2012-07-20
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL125.062271207R00000X, 2084P0800X
ND142672084P0800X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry