Provider Demographics
NPI:1255869178
Name:LAWRANCE, CHELSEA JORDAN (PAC)
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:JORDAN
Last Name:LAWRANCE
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 DARDANELLI LN STE 10
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-1418
Mailing Address - Country:US
Mailing Address - Phone:408-412-8100
Mailing Address - Fax:831-412-8499
Practice Address - Street 1:340 DARDANELLI LN STE 10
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032
Practice Address - Country:US
Practice Address - Phone:408-412-8100
Practice Address - Fax:408-412-8499
Is Sole Proprietor?:No
Enumeration Date:2017-05-24
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA288052OtherMEDICARE PTAN
CAPA54825OtherSTATE LICENSE