Healthcare Provider Details

I. General information

NPI: 1083044630
Provider Name (Legal Business Name): CHELSEA PUENTE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHELSEA AMOS

II. Dates (important events)

Enumeration Date: 11/18/2013
Last Update Date: 11/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

497 W LOTT ST
BUFFALO WY
82834-1658
US

IV. Provider business mailing address

497 W LOTT ST
BUFFALO WY
82834-1658
US

V. Phone/Fax

Practice location:
  • Phone: 307-684-5521
  • Fax: 307-684-5385
Mailing address:
  • Phone: 307-684-5521
  • Fax: 307-684-5385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number583
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: