Basic Information
Provider Information
NPI: 1497416663
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HOHENBERGER
FirstName: CHELSEA
MiddleName: R
NamePrefix:  
NameSuffix:  
Credential: NP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1 MEMORIAL SQ STE 50
Address2:  
City: GREENFIELD
State: IN
PostalCode: 461401357
CountryCode: US
TelephoneNumber: 3174686257
FaxNumber: 3174686268
Practice Location
Address1: 124 W MUSKEGON DR
Address2:  
City: GREENFIELD
State: IN
PostalCode: 461403069
CountryCode: US
TelephoneNumber: 3174684357
FaxNumber: 3174684580
Other Information
ProviderEnumerationDate: 01/10/2022
LastUpdateDate: 01/10/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 12/01/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000X71012074AINY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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