Provider Demographics
NPI:1124029954
Name:CHAPIN, SALLY J (FNP)
Entity Type:Individual
Prefix:MS
First Name:SALLY
Middle Name:J
Last Name:CHAPIN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:BROADWAY
Mailing Address - State:NC
Mailing Address - Zip Code:27505-9394
Mailing Address - Country:US
Mailing Address - Phone:919-774-6023
Mailing Address - Fax:919-258-6693
Practice Address - Street 1:101 CHURCH ST
Practice Address - Street 2:
Practice Address - City:BROADWAY
Practice Address - State:NC
Practice Address - Zip Code:27505-9394
Practice Address - Country:US
Practice Address - Phone:919-774-6023
Practice Address - Fax:919-258-6693
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200718363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1124029954OtherBCBS MEDICARE ADVANTAGE
NC7000814Medicaid
NCFH4001300OtherFIRST MEDICARE DIRECT
NCFH4001300OtherFIRST CAROLINA CARE, INC
NCFH4001300OtherFIRST MEDICARE DIRECT