Healthcare Provider Details

I. General information

NPI: 1710200795
Provider Name (Legal Business Name): EUGENE E CHAPEL RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2010
Last Update Date: 03/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N WEST AVE SUITE 300
JACKSON MI
49202-2179
US

IV. Provider business mailing address

1200 N WEST AVE SUITE 300
JACKSON MI
49202-2179
US

V. Phone/Fax

Practice location:
  • Phone: 517-789-1234
  • Fax: 517-784-7040
Mailing address:
  • Phone: 517-789-1234
  • Fax: 517-784-7040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number4704195450
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: