Provider Demographics
NPI:1225869951
Name:CHAPIN, CECELIA RENAE
Entity type:Individual
Prefix:MISS
First Name:CECELIA
Middle Name:RENAE
Last Name:CHAPIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5200 BECKNER RD UNIT 5307
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-6419
Mailing Address - Country:US
Mailing Address - Phone:260-580-8948
Mailing Address - Fax:260-580-8948
Practice Address - Street 1:4801 BECKNER RD
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-3641
Practice Address - Country:US
Practice Address - Phone:260-580-8948
Practice Address - Fax:260-580-8948
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-13
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPA2024-0086363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant