Provider Demographics
NPI:1386919850
Name:LANDOLIN, CHELSEA (RN, NP)
Entity type:Individual
Prefix:MS
First Name:CHELSEA
Middle Name:
Last Name:LANDOLIN
Suffix:
Gender:F
Credentials:RN, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1422 HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-3903
Mailing Address - Country:US
Mailing Address - Phone:510-809-1780
Mailing Address - Fax:510-893-1642
Practice Address - Street 1:1422 HARRISON ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-3903
Practice Address - Country:US
Practice Address - Phone:510-809-1780
Practice Address - Fax:510-893-1642
Is Sole Proprietor?:No
Enumeration Date:2012-03-16
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA755536363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health