Healthcare Provider Details

I. General information

NPI: 1780861302
Provider Name (Legal Business Name): DESIREE L CHAPPELL CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2008
Last Update Date: 03/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 AUDUBON PLAZA DR
LOUISVILLE KY
40217-1318
US

IV. Provider business mailing address

PO BOX 950195 DEPT. 86236
LOUISVILLE KY
40295-0195
US

V. Phone/Fax

Practice location:
  • Phone: 502-636-7160
  • Fax:
Mailing address:
  • Phone: 502-473-2100
  • Fax: 502-459-6461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1104837
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: