Provider Demographics
NPI:1902234107
Name:BURG, CHELSEA LAUREN (PAC)
Entity Type:Individual
Prefix:MRS
First Name:CHELSEA
Middle Name:LAUREN
Last Name:BURG
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 YORK ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4630
Mailing Address - Country:US
Mailing Address - Phone:920-663-9008
Mailing Address - Fax:920-684-1439
Practice Address - Street 1:2356 MEADOWS BLVD STE 340
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80109-8410
Practice Address - Country:US
Practice Address - Phone:303-761-7797
Practice Address - Fax:303-789-2995
Is Sole Proprietor?:No
Enumeration Date:2013-10-24
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5541363A00000X
COPA0003824363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO97626872Medicaid
CO026460OtherKAISER COMMERCIAL NUMBER
CO97626872Medicaid