Provider Demographics
NPI:1912320433
Name:TIEDEMANN, CHELSEA L (FNP)
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:L
Last Name:TIEDEMANN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:CHELSEA
Other - Middle Name:L
Other - Last Name:ROUTZAHN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP
Mailing Address - Street 1:1172 N MACLAY AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FERNANDO
Mailing Address - State:CA
Mailing Address - Zip Code:91340-1328
Mailing Address - Country:US
Mailing Address - Phone:818-898-1388
Mailing Address - Fax:818-270-9590
Practice Address - Street 1:2921 SAVIERS RD
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93033-5314
Practice Address - Country:US
Practice Address - Phone:805-487-5588
Practice Address - Fax:805-487-5589
Is Sole Proprietor?:No
Enumeration Date:2014-02-04
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23773363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner