MEDICARE: MS. AMANDA BROOKE CHAPMAN PA-C

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	363AS0400X	Surgical Physician Assistant	3319	AZ

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00624780	OTHER	AZ	RAILROAD MEDICARE

Other Identifiers

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

General Provider Information

NPI Number	:	1457339723
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. AMANDA BROOKE CHAPMAN PA-C

Provider Business Mailing Address
First Line	:	2320 N 3RD ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85004-1303
Country	:	US
Telephone Number	:	602-258-9900
Fax Number	:	602-258-9904

Provider Business Practice Location Address
First Line	:	9250 W THOMAS RD
Second Line	:	SUITE 250
City	:	PHOENIX
State	:	AZ
Zip	:	85037-3382
Country	:	US
Telephone Number	:	623-936-5406
Fax Number	:	623-936-5479

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

Provider Enumeration Date	:	01/05/2006
Last Update Date	:	08/05/2015

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