Healthcare Provider Details

I. General information

NPI: 1811758626
Provider Name (Legal Business Name): CATHRYN CHAPA CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2024
Last Update Date: 01/18/2024
Certification Date: 01/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49650 CHERRY HILL RD STE 210
CANTON MI
48187-4859
US

IV. Provider business mailing address

3198 PRESCOTT DR
HOWELL MI
48843-6975
US

V. Phone/Fax

Practice location:
  • Phone: 734-398-7899
  • Fax:
Mailing address:
  • Phone: 248-924-1043
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number4704341676
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: