Provider Demographics
NPI:1962238154
Name:CULBERSON, CHELSEA NICOLE
Entity type:Individual
Prefix:
First Name:CHELSEA
Middle Name:NICOLE
Last Name:CULBERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6227 GRAVOIS AVE # 1F
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63116-2203
Mailing Address - Country:US
Mailing Address - Phone:636-233-2854
Mailing Address - Fax:
Practice Address - Street 1:6227 GRAVOIS AVE # 1F
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63116-2203
Practice Address - Country:US
Practice Address - Phone:636-233-2854
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-12
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health