Provider Demographics
NPI:1255890026
Name:DELUCA, CHELSEA RAE (NP)
Entity type:Individual
Prefix:MRS
First Name:CHELSEA
Middle Name:RAE
Last Name:DELUCA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 WEST GRAND RIVER AVE
Mailing Address - Street 2:#200
Mailing Address - City:HOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48843
Mailing Address - Country:US
Mailing Address - Phone:517-273-9090
Mailing Address - Fax:517-518-8629
Practice Address - Street 1:1225 WEST GRAND RIVER AVE
Practice Address - Street 2:#200
Practice Address - City:HOWELL
Practice Address - State:MI
Practice Address - Zip Code:48843
Practice Address - Country:US
Practice Address - Phone:517-273-9090
Practice Address - Fax:517-518-8629
Is Sole Proprietor?:No
Enumeration Date:2019-03-19
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704311012363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily