Healthcare Provider Details

I. General information

NPI: 1902455900
Provider Name (Legal Business Name): NATALIA D CHAPMAN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2019
Last Update Date: 12/17/2020
Certification Date: 12/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 22ND AVE
MONROE WI
53566
US

IV. Provider business mailing address

2802 CISSERVILLE RD
SOUTH WAYNE WI
53587-9744
US

V. Phone/Fax

Practice location:
  • Phone: 608-324-2000
  • Fax:
Mailing address:
  • Phone: 920-763-2497
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number4840
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: