Healthcare Provider Details

I. General information

NPI: 1790810810
Provider Name (Legal Business Name): COLLEEN CHAPPELL R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 SOUTH MAIN
LOA UT
84747
US

IV. Provider business mailing address

PO BOX 1475
LYMAN UT
84749-1475
US

V. Phone/Fax

Practice location:
  • Phone: 435-836-1316
  • Fax: 435-836-1316
Mailing address:
  • Phone: 435-736-1316
  • Fax: 435-896-4353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number207235-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: