Provider Demographics
NPI:1518708874
Name:MCCREARY, CHELSEA (NP)
Entity type:Individual
Prefix:
First Name:CHELSEA
Middle Name:
Last Name:MCCREARY
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 1:20873 MILBANK ST
Mailing Address - Street 2:
Mailing Address - City:WOODHAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:48183-4368
Mailing Address - Country:US
Mailing Address - Phone:313-932-7661
Mailing Address - Fax:
Practice Address - Street 1:20873 MILBANK ST
Practice Address - Street 2:
Practice Address - City:WOODHAVEN
Practice Address - State:MI
Practice Address - Zip Code:48183-4368
Practice Address - Country:US
Practice Address - Phone:313-932-7661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704346703363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner