MEDICARE: DANIELLE CHAPDELAINE PA-C

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	363A00000X	Physician Assistant	11687047-1206	UT

General Provider Information

NPI Number	:	1326863838
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIELLE CHAPDELAINE PA-C

Provider Business Mailing Address
First Line	:	PO BOX 27128
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84127-0128
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5063 S COTTONWOOD ST STE 120
Second Line	:
City	:	MURRAY
State	:	UT
Zip	:	84107-6772
Country	:	US
Telephone Number	:	801-870-7974
Fax Number	:

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

Provider Enumeration Date	:	11/19/2024
Last Update Date	:	11/24/2025

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