Provider Demographics
NPI:1831600519
Name:MAINOUS, CHELSEA M (CNP)
Entity type:Individual
Prefix:
First Name:CHELSEA
Middle Name:M
Last Name:MAINOUS
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:CHELSEA
Other - Middle Name:M
Other - Last Name:DEAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 SEAGATE # 800
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-1558
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:419-824-7359
Practice Address - Street 1:2142 N COVE BLVD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-3895
Practice Address - Country:US
Practice Address - Phone:419-291-4491
Practice Address - Fax:419-479-6905
Is Sole Proprietor?:No
Enumeration Date:2017-10-20
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.021947363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0257160Medicaid