Healthcare Provider Details

I. General information

NPI: 1932193315
Provider Name (Legal Business Name): MARILYN Y CHAPMAN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2005
Last Update Date: 12/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 W MAIN
MATTHEWS MO
63867
US

IV. Provider business mailing address

PO BOX 358
MATTHEWS MO
63867-0358
US

V. Phone/Fax

Practice location:
  • Phone: 573-471-1514
  • Fax: 573-471-1517
Mailing address:
  • Phone: 573-471-1514
  • Fax: 573-471-1517

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number126551
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: