MEDICARE: MRS. RAQUEL G CHAPPELLE CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	1-069705	AL
2	367500000X	Certified Registered Nurse Anesthetist	658822	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124085022
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. RAQUEL G CHAPPELLE CRNA

Provider Business Mailing Address
First Line	:	243 CAROLINA CT
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36117-4382
Country	:	US
Telephone Number	:	334-279-1802
Fax Number	:	334-293-8062

Provider Business Practice Location Address
First Line	:	7703 FLOYD CURL DRIVE
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-3900
Country	:	US
Telephone Number	:	210-567-4500
Fax Number	:	210-567-0083

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/26/2006
Last Update Date	:	05/06/2009

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