Provider Demographics
NPI:1750168787
Name:HALVERSON, CHELSEA (LM, CPM)
Entity type:Individual
Prefix:
First Name:CHELSEA
Middle Name:
Last Name:HALVERSON
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16024 S MALLOY PRAIRIE RD
Mailing Address - Street 2:
Mailing Address - City:CHENEY
Mailing Address - State:WA
Mailing Address - Zip Code:99004-7964
Mailing Address - Country:US
Mailing Address - Phone:509-220-2316
Mailing Address - Fax:
Practice Address - Street 1:16024 S MALLOY PRAIRIE RD
Practice Address - Street 2:
Practice Address - City:CHENEY
Practice Address - State:WA
Practice Address - Zip Code:99004-7964
Practice Address - Country:US
Practice Address - Phone:509-220-2316
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-13
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDMID-150176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife