Provider Demographics
NPI:1376283531
Name:MERSEREAU, CHELSEA NOEL
Entity type:Individual
Prefix:
First Name:CHELSEA
Middle Name:NOEL
Last Name:MERSEREAU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHELSEA
Other - Middle Name:NOEL
Other - Last Name:HOWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7147 SE CLACKAMAS RD
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97267-3301
Mailing Address - Country:US
Mailing Address - Phone:503-729-4487
Mailing Address - Fax:
Practice Address - Street 1:7110 SW FIR LOOP STE 160
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-8031
Practice Address - Country:US
Practice Address - Phone:971-500-3494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-29
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist