Basic Information
| Provider Information | |||||||||
| NPI: | 1598140857 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BARTLETT | ||||||||
| FirstName: | CHELSEA | ||||||||
| MiddleName: | GREENWAY | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | FNP-C | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | GREENWAY | ||||||||
| OtherFirstName: | CHELSEA | ||||||||
| OtherMiddleName: | DAWN | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2025 E GREENWAY PL | ||||||||
| Address2: | |||||||||
| City: | VINTON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 241791140 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5408154163 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5330 PETERS CREEK RD STE D1 | ||||||||
| Address2: | |||||||||
| City: | ROANOKE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 240193853 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5403660927 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2015 | ||||||||
| LastUpdateDate: | 10/17/2022 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 10/17/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2255A2300X | 026002383 | VA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer | 363LF0000X | 0024184975 | VA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.