Provider Demographics
NPI:1215498449
Name:CHAPMAN, ELLEN J
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:J
Last Name:CHAPMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ELLEN
Other - Middle Name:J
Other - Last Name:CHAPMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ELLEN J GLOVER
Mailing Address - Street 1:PO BOX 24
Mailing Address - Street 2:
Mailing Address - City:CONNERVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74836-0024
Mailing Address - Country:US
Mailing Address - Phone:405-410-5828
Mailing Address - Fax:
Practice Address - Street 1:801 E MAIN ST
Practice Address - Street 2:
Practice Address - City:TISHOMINGO
Practice Address - State:OK
Practice Address - Zip Code:73460-2351
Practice Address - Country:US
Practice Address - Phone:580-371-3776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-29
Last Update Date:2019-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator