Provider Demographics
NPI:1417312554
Name:PRUGAR, CHELSEY E (PA-C)
Entity Type:Individual
Prefix:
First Name:CHELSEY
Middle Name:E
Last Name:PRUGAR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CHELSEY
Other - Middle Name:E
Other - Last Name:TEWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:82 HIDDEN VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-5216
Mailing Address - Country:US
Mailing Address - Phone:207-351-5339
Mailing Address - Fax:
Practice Address - Street 1:82 HIDDEN VALLEY DR
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-5216
Practice Address - Country:US
Practice Address - Phone:207-351-5339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-16
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1153363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3103419Medicaid