Doctor Name: | CHELSEA BROCKETT |
NPI Number: | 1205243318 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | MA057004 |
Business Practice Address: | 503 Main St Bellwood, PA - 166171909 |
Business Phone Number: | 8147428400 |
Business Fax Number: | 8147429852 |
Mailing Address: | 1414 9th Ave, ALTOONA |
State: | PA |
Postal Code: | 166022415 |
Phone Number: | 8149461655 |
Fax Number: | 8149497616 |
NPI Enumeration Date: | 07/21/2014 |
NPI Last Update Date: | 07/21/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | MA057004 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | PA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |