Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 95013500 | CA |
NPI | 1013588102 |
---|---|
Provider Name | Chelsea Addy |
First Address | Sunset Beach, CA 90742-1725 |
Second Address | Woodland Hills, CA 91367-7037 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2021 |
Last Update Date | 08/07/2021 |