Basic Information
| Provider Information | |||||||||
| NPI: | 1811301245 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LAWRENZ | ||||||||
| FirstName: | CHELSEA | ||||||||
| MiddleName: | RENEE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PA-C | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | WILLIAMSON | ||||||||
| OtherFirstName: | CHELSEA | ||||||||
| OtherMiddleName: | RENEE | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 501 AIRPORT RD | ||||||||
| Address2: | |||||||||
| City: | RIFLE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 816508510 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9706251100 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 501 AIRPORT RD | ||||||||
| Address2: | |||||||||
| City: | RIFLE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 81650 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9706251100 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2014 | ||||||||
| LastUpdateDate: | 07/25/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA.0004734 | CO | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 00155063 | 05 | CO | MEDICAID |