Provider Demographics
NPI:1962810283
Name:CHAPMAN, LISA SANDOVAL (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:SANDOVAL
Last Name:CHAPMAN
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
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Mailing Address - Street 1:1920 E HERBERT AVE
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84108-1834
Mailing Address - Country:US
Mailing Address - Phone:801-597-9037
Mailing Address - Fax:
Practice Address - Street 1:1046 E 100 S
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-1520
Practice Address - Country:US
Practice Address - Phone:801-746-2885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-30
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT9008826-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant