Healthcare Provider Details

I. General information

NPI: 1528588357
Provider Name (Legal Business Name): CHELSEA MAE PEDROZA APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2017
Last Update Date: 01/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2620 W FAIDLEY AVE
GRAND ISLAND NE
68803-4205
US

IV. Provider business mailing address

742 E 7TH ST
HASTINGS NE
68901-7602
US

V. Phone/Fax

Practice location:
  • Phone: 308-384-4600
  • Fax:
Mailing address:
  • Phone: 402-469-1892
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number112290
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: