Provider Demographics
NPI:1194899476
Name:CHAPPELL, MARY LOU (NP CNM)
Entity type:Individual
Prefix:
First Name:MARY LOU
Middle Name:
Last Name:CHAPPELL
Suffix:
Gender:F
Credentials:NP CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 LANSING ST
Mailing Address - Street 2:AMMS, PC CREDENTIALING OFFICE
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-1983
Mailing Address - Country:US
Mailing Address - Phone:315-255-7438
Mailing Address - Fax:315-255-7099
Practice Address - Street 1:143 NORTH ST
Practice Address - Street 2:SUITE #4
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-1852
Practice Address - Country:US
Practice Address - Phone:315-252-5028
Practice Address - Fax:315-252-1587
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY307356-1163W00000X
NYF420219-1363LW0102X
NYF000976367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03063027Medicaid
NY03063027Medicaid