Provider Demographics
NPI:1992302764
Name:CHAPMAN, MICHELLE M (LPN)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:M
Last Name:CHAPMAN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 E NORTHSIDE DR # 910E
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39206-5533
Mailing Address - Country:US
Mailing Address - Phone:866-553-2659
Mailing Address - Fax:866-553-2659
Practice Address - Street 1:910 E NORTHSIDE DR # 910E
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39206-5533
Practice Address - Country:US
Practice Address - Phone:866-553-2659
Practice Address - Fax:866-553-2659
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-05
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS331219164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS331219OtherNURSING LICENSE