Provider Demographics
NPI:1326553199
Name:CHAPPELL, MAKENZIE PORTER (RN, BSN)
Entity Type:Individual
Prefix:
First Name:MAKENZIE
Middle Name:PORTER
Last Name:CHAPPELL
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 S DAIRY RD
Mailing Address - Street 2:
Mailing Address - City:CENTRAL VALLEY
Mailing Address - State:UT
Mailing Address - Zip Code:84754-3283
Mailing Address - Country:US
Mailing Address - Phone:435-691-4822
Mailing Address - Fax:
Practice Address - Street 1:630 S DAIRY RD
Practice Address - Street 2:
Practice Address - City:CENTRAL VALLEY
Practice Address - State:UT
Practice Address - Zip Code:84754-3283
Practice Address - Country:US
Practice Address - Phone:435-691-4822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-02
Last Update Date:2017-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8650342-3102163WX0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX0106XNursing Service ProvidersRegistered NurseOccupational Health