Provider Demographics
NPI:1457339723
Name:CHAPMAN, AMANDA BROOKE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:BROOKE
Last Name:CHAPMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2320 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004-1303
Mailing Address - Country:US
Mailing Address - Phone:602-258-9900
Mailing Address - Fax:602-258-9904
Practice Address - Street 1:9250 W THOMAS RD
Practice Address - Street 2:SUITE 250
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-3382
Practice Address - Country:US
Practice Address - Phone:623-936-5406
Practice Address - Fax:623-936-5479
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3319363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZP00624780OtherRAILROAD MEDICARE
AZ104351Medicaid
AZZ123308Medicare PIN
Z111889Medicare PIN
AZQ63659Medicare UPIN
AZ108158Medicare PIN