Provider Demographics
NPI:1447589338
Name:CHAPPELL, KHADIJAH IMANI (CNA)
Entity Type:Individual
Prefix:
First Name:KHADIJAH
Middle Name:IMANI
Last Name:CHAPPELL
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2819 W 8TH STREET
Mailing Address - Street 2:
Mailing Address - City:CINTI
Mailing Address - State:OH
Mailing Address - Zip Code:45204
Mailing Address - Country:US
Mailing Address - Phone:513-687-7934
Mailing Address - Fax:
Practice Address - Street 1:2819 W 8TH STREET
Practice Address - Street 2:
Practice Address - City:CINTI
Practice Address - State:OH
Practice Address - Zip Code:45204
Practice Address - Country:US
Practice Address - Phone:513-687-7934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-24
Last Update Date:2009-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3651560376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide