Healthcare Provider Details

I. General information

NPI: 1457339723
Provider Name (Legal Business Name): AMANDA BROOKE CHAPMAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2006
Last Update Date: 08/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9250 W THOMAS RD SUITE 250
PHOENIX AZ
85037-3382
US

IV. Provider business mailing address

2320 N 3RD ST
PHOENIX AZ
85004-1303
US

V. Phone/Fax

Practice location:
  • Phone: 623-936-5406
  • Fax: 623-936-5479
Mailing address:
  • Phone: 602-258-9900
  • Fax: 602-258-9904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number3319
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: