Provider Demographics
NPI:1265539159
Name:CHAPMAN, KIANDRIA NICOLE (RN)
Entity type:Individual
Prefix:MS
First Name:KIANDRIA
Middle Name:NICOLE
Last Name:CHAPMAN
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 1:10126 W CAPITOL DR
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53222-1320
Mailing Address - Country:US
Mailing Address - Phone:414-438-1848
Mailing Address - Fax:
Practice Address - Street 1:12250 W NORTH AVE APT 222 BLDG A-
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-2066
Practice Address - Country:US
Practice Address - Phone:414-476-5303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI141360 - 30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38315600Medicaid