Provider Demographics
NPI:1578710299
Name:CHAPPELL, ILSY (MS, RD, LDN)
Entity Type:Individual
Prefix:
First Name:ILSY
Middle Name:
Last Name:CHAPPELL
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 W LANE ST
Mailing Address - Street 2:UNIT 102
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27603-1486
Mailing Address - Country:US
Mailing Address - Phone:919-667-6799
Mailing Address - Fax:
Practice Address - Street 1:701 W LANE ST
Practice Address - Street 2:UNIT 102
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27603-1486
Practice Address - Country:US
Practice Address - Phone:919-667-6799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-25
Last Update Date:2011-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL003235133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered