Provider Demographics
NPI:1972168755
Name:MAKOWSKI, CHELSEY (LPN)
Entity type:Individual
Prefix:
First Name:CHELSEY
Middle Name:
Last Name:MAKOWSKI
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1507 FAIRLANE AVE SW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44710-1351
Mailing Address - Country:US
Mailing Address - Phone:330-806-9012
Mailing Address - Fax:
Practice Address - Street 1:1507 FAIRLANE AVE SW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44710-1351
Practice Address - Country:US
Practice Address - Phone:330-806-9012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-07
Last Update Date:2019-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN.166386164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse