Provider Demographics
NPI:1750683462
Name:CHAPMAN, BRENDA LEE
Entity Type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:LEE
Last Name:CHAPMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 ROBERTS AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:MS
Mailing Address - Zip Code:39560-4020
Mailing Address - Country:US
Mailing Address - Phone:228-868-7199
Mailing Address - Fax:228-868-9769
Practice Address - Street 1:210 ROBERTS AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:MS
Practice Address - Zip Code:39560-4020
Practice Address - Country:US
Practice Address - Phone:228-868-7199
Practice Address - Fax:228-868-9769
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-01
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS687372600000X, 3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant