Provider Demographics
NPI:1790810810
Name:CHAPPELL, COLLEEN (RN)
Entity Type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:
Last Name:CHAPPELL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1475
Mailing Address - Street 2:
Mailing Address - City:LYMAN
Mailing Address - State:UT
Mailing Address - Zip Code:84749-1475
Mailing Address - Country:US
Mailing Address - Phone:435-736-1316
Mailing Address - Fax:435-896-4353
Practice Address - Street 1:18 SOUTH MAIN
Practice Address - Street 2:
Practice Address - City:LOA
Practice Address - State:UT
Practice Address - Zip Code:84747
Practice Address - Country:US
Practice Address - Phone:435-836-1316
Practice Address - Fax:435-836-1316
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT207235-3102163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health