MEDICARE: MRS. CHA'KQUALYA ANNTRINETT CHAPPELL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1033923578
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHA'KQUALYA ANNTRINETT CHAPPELL

Provider Business Mailing Address
First Line	:	4518 CHAPEL RIDGE LN APT 3
Second Line	:
City	:	COUNCIL BLUFFS
State	:	IA
Zip	:	51501-8577
Country	:	US
Telephone Number	:	402-510-7325
Fax Number	:

Provider Business Practice Location Address
First Line	:	7063 CROWN POINT AVE APT 316
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68104-5308
Country	:	US
Telephone Number	:	402-510-7325
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/05/2025
Last Update Date	:	02/05/2025

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