Healthcare Provider Details

I. General information

NPI: 1326553199
Provider Name (Legal Business Name): MAKENZIE PORTER CHAPPELL RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2017
Last Update Date: 12/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 S DAIRY RD
CENTRAL VALLEY UT
84754-3283
US

IV. Provider business mailing address

630 S DAIRY RD
CENTRAL VALLEY UT
84754-3283
US

V. Phone/Fax

Practice location:
  • Phone: 435-691-4822
  • Fax:
Mailing address:
  • Phone: 435-691-4822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0106X
TaxonomyOccupational Health Registered Nurse
License Number8650342-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: