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General NPI Number Information
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NPI Number | 1720674732
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Entity Type | Individual
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Provider Name | CHELSEA BOSAK AGACNP-BC
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Gender | Female
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Dates
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Enumeration Date | 12/14/2020
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Last Update Date | 03/04/2021
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Provider Practice Location Address
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Address Line | 5750 W THUNDERBIRD RD BLDG G STE 780
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City | GLENDALE
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State | AZ
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Zip | 85306-4682
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Country | US
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Telephone | 602-314-4220
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Fax | 602-314-5631
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Provider Business Mailing Address
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Address Line | 13634 N 93RD AVE STE 100
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City | PEORIA
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State | AZ
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Zip | 85381-4915
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Country | US
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Telephone | 623-933-0301
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 250699
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 250699
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 250699
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License Number State | AZ
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