MEDICARE: NAOMI R CHIPLEY

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	363LF0000X	Family Nurse Practitioner	255920	AZ

General Provider Information

NPI Number	:	1265172894
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NAOMI R CHIPLEY

Provider Business Mailing Address
First Line	:	4432 S ANTONIO CIR
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85212-5220
Country	:	US
Telephone Number	:	480-395-8386
Fax Number	:

Provider Business Practice Location Address
First Line	:	4432 S ANTONIO CIR
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85212-5220
Country	:	US
Telephone Number	:	480-395-8386
Fax Number	:

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

Provider Enumeration Date	:	03/31/2022
Last Update Date	:	03/31/2022

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Directions to “ NAOMI R CHIPLEY ” Practice Location

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