Provider Demographics
NPI:1215702048
Name:BIANCHI, CHELSEY MARIE
Entity type:Individual
Prefix:
First Name:CHELSEY
Middle Name:MARIE
Last Name:BIANCHI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHELSEY
Other - Middle Name:
Other - Last Name:STARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1230 E RUSHOLME ST MEDICAL OFFICE BUILDING 2
Mailing Address - Street 2:SUITE 207
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52803-3573
Mailing Address - Country:US
Mailing Address - Phone:563-421-8980
Mailing Address - Fax:
Practice Address - Street 1:1230 E RUSHOLME ST MEDICAL OFFICE BUILDING 2
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52803-3573
Practice Address - Country:US
Practice Address - Phone:563-421-8980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-21
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA176131363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily