Provider Demographics
NPI:1720674732
Name:BOSAK, CHELSEA (AGACNP-BC)
Entity type:Individual
Prefix:
First Name:CHELSEA
Middle Name:
Last Name:BOSAK
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:CHELSEA
Other - Middle Name:
Other - Last Name:HAILPERN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSN, RN
Mailing Address - Street 1:13634 N 93RD AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-4915
Mailing Address - Country:US
Mailing Address - Phone:623-933-0301
Mailing Address - Fax:
Practice Address - Street 1:5750 W THUNDERBIRD RD
Practice Address - Street 2:BLDG G STE 780
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-4682
Practice Address - Country:US
Practice Address - Phone:602-314-4220
Practice Address - Fax:602-314-5631
Is Sole Proprietor?:No
Enumeration Date:2020-12-14
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ250699363LA2200X, 363LG0600X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
2020092576OtherANCC
AZRN177672OtherRN
AZ250699OtherANRN-RNP