Provider Demographics
NPI:1255679726
Name:RICHARDSON, CHELSEA MARIE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:CHELSEA
Middle Name:MARIE
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CHELSEA
Other - Middle Name:
Other - Last Name:FIBRANZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 3755
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68103-0755
Mailing Address - Country:US
Mailing Address - Phone:402-354-2100
Mailing Address - Fax:402-354-2155
Practice Address - Street 1:101 E CENTENNIAL RD
Practice Address - Street 2:
Practice Address - City:PAPILLION
Practice Address - State:NE
Practice Address - Zip Code:68046-2079
Practice Address - Country:US
Practice Address - Phone:402-354-7750
Practice Address - Fax:402-354-2079
Is Sole Proprietor?:No
Enumeration Date:2013-01-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA002376363A00000X
NE2156363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47068731734Medicaid
NE47068731741Medicaid
NE47068731749Medicaid
NE10026480100Medicaid
NE47068731721Medicaid