Individual provider Active NPI

Chelsea Jayne Self, BSN, RN, PHN

  • Registered Nurse
  • Marshall, MN
National Provider Identifier
1790323210
Registry record updated Dec 16, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered NurseTaxonomy code 163W00000X
License
2458312 Issued in MN
Practice address
607 W Main St Ste 200
Marshall, MN 56258-3171
Phone
(507) 537-6713
Fax
(507) 537-6088
NPI assigned
Dec 16, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 16, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 2458312 MN Primary

Addresses

Primary practice location

607 W Main St Ste 200
Marshall, MN 56258-3171

Mailing address

607 W Main St Ste 200
Marshall, MN 56258-3171
Phone (507) 537-6713

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Bachelor on Science - Nursing, Registered Nurse

State licenses

LicenseStateTypeSpecialty
2458312MNMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Southwest Health and Human Services CurrentSince Sep 11, 2022 Accepting new patients
Southwest Health and Human Services Past Accepting new patients

Locations

607 W Main St
Ste 200
Marshall, MN 56258
Phone (507) 532-1242

607 W Main St
Marshall, MN 56258
Phone (507) 532-1242

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1576454400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1576454400000",
    "number": "1790323210",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "607 W MAIN ST STE 200",
            "city": "MARSHALL",
            "state": "MN",
            "postal_code": "562583171",
            "telephone_number": "507-537-6713",
            "fax_number": "507-537-6088"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "607 W MAIN ST STE 200",
            "city": "MARSHALL",
            "state": "MN",
            "postal_code": "562583171",
            "telephone_number": "507-537-6713",
            "fax_number": "507-537-6088"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SELF",
        "first_name": "CHELSEA",
        "middle_name": "JAYNE",
        "name_prefix": "Miss",
        "credential": "BSN, RN, PHN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-12-16",
        "last_updated": "2019-12-16",
        "certification_date": "2019-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MN",
            "license": "2458312",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Marshall, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.