Provider Demographics
NPI:1396394904
Name:SMITH, CHELSEA NICHOLE (MSN-CNM)
Entity type:Individual
Prefix:MRS
First Name:CHELSEA
Middle Name:NICHOLE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MSN-CNM
Other - Prefix:MRS
Other - First Name:CHELSEA
Other - Middle Name:NICHOLE
Other - Last Name:CARR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15089 53S WAY NW
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:ND
Mailing Address - Zip Code:58801-9365
Mailing Address - Country:US
Mailing Address - Phone:701-989-4084
Mailing Address - Fax:
Practice Address - Street 1:15089 53S WAY NW
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:ND
Practice Address - Zip Code:58801-9365
Practice Address - Country:US
Practice Address - Phone:019-894-0847
Practice Address - Fax:701-425-0335
Is Sole Proprietor?:No
Enumeration Date:2019-09-06
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTNUR-APRN-LIC-179181367A00000X
NDR38310367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1478707Medicaid