Provider Demographics
NPI:1407642614
Name:GAUTHIER, CHELSEA LYNN
Entity type:Individual
Prefix:
First Name:CHELSEA
Middle Name:LYNN
Last Name:GAUTHIER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1375 CALLE DEL ORO
Mailing Address - Street 2:
Mailing Address - City:BOSQUE FARMS
Mailing Address - State:NM
Mailing Address - Zip Code:87068-9795
Mailing Address - Country:US
Mailing Address - Phone:505-917-1213
Mailing Address - Fax:
Practice Address - Street 1:3736 EUBANK BLVD NE STE B1
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-3583
Practice Address - Country:US
Practice Address - Phone:505-293-2881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-15
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program