Healthcare Provider Details

I. General information

NPI: 1578855367
Provider Name (Legal Business Name): MOLLY CHAPMAN CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2011
Last Update Date: 05/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HOPE DR
TUSTIN CA
92782-0221
US

IV. Provider business mailing address

227 20TH ST SUITE 100
NEWPORT BEACH CA
92663-4343
US

V. Phone/Fax

Practice location:
  • Phone: 714-247-0300
  • Fax: 714-259-0843
Mailing address:
  • Phone: 714-434-2587
  • Fax: 714-434-1835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberRN309596
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: