Provider Demographics
NPI:1972901577
Name:HINMON, CHENELLE RAE (CRNP)
Entity type:Individual
Prefix:
First Name:CHENELLE
Middle Name:RAE
Last Name:HINMON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 MARKET ST
Mailing Address - Street 2:LM 500 WEST TOWER
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19102-2100
Mailing Address - Country:US
Mailing Address - Phone:215-985-2595
Mailing Address - Fax:
Practice Address - Street 1:5675 N FRONT ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19120-2719
Practice Address - Country:US
Practice Address - Phone:215-279-9666
Practice Address - Fax:215-279-9674
Is Sole Proprietor?:No
Enumeration Date:2014-12-12
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN531824163WP2201X
PASP014676363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care