Provider Demographics
NPI:1629734926
Name:CHAPPEL, MALCOLM (CPRSS)
Entity Type:Individual
Prefix:
First Name:MALCOLM
Middle Name:
Last Name:CHAPPEL
Suffix:
Gender:M
Credentials:CPRSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 S 21ST ST
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89431-8100
Mailing Address - Country:US
Mailing Address - Phone:775-276-2953
Mailing Address - Fax:
Practice Address - Street 1:605 S 21ST ST
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89431-8100
Practice Address - Country:US
Practice Address - Phone:775-276-2953
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-10
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5006175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist