MEDICARE: MRS. JANICE LUCILLE CHAPMAN PA

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	PA10002079	WA

General Provider Information

NPI Number	:	1770578056
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JANICE LUCILLE CHAPMAN PA

Provider Business Mailing Address
First Line	:	3224 MEADOWLARK DR
Second Line	:
City	:	LEWISTON
State	:	ID
Zip	:	83501-8605
Country	:	US
Telephone Number	:	208-746-9039
Fax Number	:

Provider Business Practice Location Address
First Line	:	320 WARNER DR
Second Line	:
City	:	LEWISTON
State	:	ID
Zip	:	83501-4441
Country	:	US
Telephone Number	:	208-743-3523
Fax Number	:	208-746-8741

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

Provider Enumeration Date	:	09/13/2005
Last Update Date	:	07/08/2007

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