=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528493822
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SUSAN E CHAPPELL RN,MSN,FNP-BC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/05/2013
-----------------------------------------------------
Last Update Date | 09/05/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 239 MILLER AVE SUITE 8
-----------------------------------------------------
City | MILL VALLEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94941-2841
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-888-3662
-----------------------------------------------------
Fax | 415-888-6272
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 239 MILLER AVE
-----------------------------------------------------
City | MILL VALLEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94941-2841
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-888-3662
-----------------------------------------------------
Fax | 415-888-6272
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 669372
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------