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General NPI Number Information
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NPI Number | 1821695792
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Entity Type | Individual
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Provider Name | CHELSEA DYLAN TENNENT PA-C
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Gender | Female
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Dates
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Enumeration Date | 10/05/2020
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Last Update Date | 12/26/2025
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Provider Practice Location Address
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Address Line | 376 S LATAH ST
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City | BOISE
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State | ID
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Zip | 83705-1539
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Country | US
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Telephone | 208-579-5767
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Fax | 208-579-5766
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Provider Business Mailing Address
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Address Line | 1666 E GENTLEWIND ST
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City | BOISE
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State | ID
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Zip | 83706-5914
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Country | US
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Telephone | 208-830-5018
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | GPA-068
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License Number State | ID
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