Provider Demographics
NPI:1770984387
Name:SROUFE, CHELSEA JUNE (RN)
Entity type:Individual
Prefix:MRS
First Name:CHELSEA
Middle Name:JUNE
Last Name:SROUFE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:CHELSEA
Other - Middle Name:
Other - Last Name:DAVIDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:2766 11 MILE RD
Mailing Address - Street 2:#2
Mailing Address - City:BERKLEY
Mailing Address - State:MI
Mailing Address - Zip Code:48072-3033
Mailing Address - Country:US
Mailing Address - Phone:248-542-2424
Mailing Address - Fax:
Practice Address - Street 1:22448 BAYVIEW DR
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48081-2408
Practice Address - Country:US
Practice Address - Phone:586-776-6927
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-15
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704299189163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse