Provider Demographics
NPI:1033631700
Name:PROVENZANO, CHELSEA (MSN, FNP- C)
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:
Last Name:PROVENZANO
Suffix:
Gender:F
Credentials:MSN, FNP- C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13627 SUNSET VIEW RD
Mailing Address - Street 2:
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-5051
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8851 CENTER DR STE 408
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-3076
Practice Address - Country:US
Practice Address - Phone:619-583-1174
Practice Address - Fax:619-583-4609
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-13
Last Update Date:2017-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95006939363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily