Provider Demographics
NPI:1083044630
Name:PUENTE, CHELSEA (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:CHELSEA
Middle Name:
Last Name:PUENTE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CHELSEA
Other - Middle Name:
Other - Last Name:AMOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:497 W LOTT ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:WY
Mailing Address - Zip Code:82834-1658
Mailing Address - Country:US
Mailing Address - Phone:307-684-5521
Mailing Address - Fax:307-684-5385
Practice Address - Street 1:497 W LOTT ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:WY
Practice Address - Zip Code:82834-1658
Practice Address - Country:US
Practice Address - Phone:307-684-5521
Practice Address - Fax:307-684-5385
Is Sole Proprietor?:No
Enumeration Date:2013-11-18
Last Update Date:2013-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY583363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant