Provider Demographics
NPI:1508268491
Name:REICH, CHELSEA A (PA-C)
Entity type:Individual
Prefix:
First Name:CHELSEA
Middle Name:A
Last Name:REICH
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:CHELSEA
Other - Middle Name:A
Other - Last Name:VAN DYKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:3625 LINCOLN ST S STE C
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-7766
Mailing Address - Country:US
Mailing Address - Phone:701-532-2458
Mailing Address - Fax:
Practice Address - Street 1:3625 LINCOLN ST S STE C
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-7766
Practice Address - Country:US
Practice Address - Phone:701-532-2458
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-23
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1012363A00000X
MN12887363A00000X
NDPAC0762363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant