Healthcare Provider Details

I. General information

NPI: 1831929546
Provider Name (Legal Business Name): CHELSEA-LYNNE ULUWEHI KOSAREFF PNP, RN, CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2024
Last Update Date: 08/06/2024
Certification Date: 08/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 VALLEY CHILDRENS PL
MADERA CA
93636-8762
US

IV. Provider business mailing address

9300 VALLEY CHILDRENS PL
MADERA CA
93636-8762
US

V. Phone/Fax

Practice location:
  • Phone: 559-353-5404
  • Fax:
Mailing address:
  • Phone: 808-688-6806
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number95030719
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: