Healthcare Provider Details

I. General information

NPI: 1720674732
Provider Name (Legal Business Name): CHELSEA BOSAK AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHELSEA HAILPERN BSN, RN

II. Dates (important events)

Enumeration Date: 12/14/2020
Last Update Date: 03/04/2021
Certification Date: 03/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5750 W THUNDERBIRD RD BLDG G STE 780
GLENDALE AZ
85306-4682
US

IV. Provider business mailing address

13634 N 93RD AVE STE 100
PEORIA AZ
85381-4915
US

V. Phone/Fax

Practice location:
  • Phone: 602-314-4220
  • Fax: 602-314-5631
Mailing address:
  • Phone: 623-933-0301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number250699
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number250699
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number250699
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: