Provider Demographics
NPI:1598502650
Name:OLDAKOWSKI, CHANTEL LEE (FNP)
Entity type:Individual
Prefix:
First Name:CHANTEL
Middle Name:LEE
Last Name:OLDAKOWSKI
Suffix:
Gender:
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 2ND ST SE
Mailing Address - Street 2:
Mailing Address - City:LITTLE FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56345-3559
Mailing Address - Country:US
Mailing Address - Phone:320-631-7000
Mailing Address - Fax:
Practice Address - Street 1:811 2ND ST SE STE A
Practice Address - Street 2:
Practice Address - City:LITTLE FALLS
Practice Address - State:MN
Practice Address - Zip Code:56345-3558
Practice Address - Country:US
Practice Address - Phone:320-631-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-15
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN11780363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily