Provider Demographics
NPI:1700484235
Name:WALLER, CHELSEY ANN (CNM, WHNP)
Entity Type:Individual
Prefix:
First Name:CHELSEY
Middle Name:ANN
Last Name:WALLER
Suffix:
Gender:F
Credentials:CNM, WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1035 ONTARIO ST
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93035-1516
Mailing Address - Country:US
Mailing Address - Phone:707-486-0438
Mailing Address - Fax:
Practice Address - Street 1:1200 6TH ST STE 400
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-2369
Practice Address - Country:US
Practice Address - Phone:231-392-0650
Practice Address - Fax:231-392-0665
Is Sole Proprietor?:No
Enumeration Date:2020-10-16
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704368892176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife