Provider Demographics
NPI:1770578056
Name:CHAPMAN, JANICE LUCILLE (PA)
Entity type:Individual
Prefix:MRS
First Name:JANICE
Middle Name:LUCILLE
Last Name:CHAPMAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:JANICE
Other - Middle Name:L
Other - Last Name:ROUBIDOUX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3224 MEADOWLARK DR
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-8605
Mailing Address - Country:US
Mailing Address - Phone:208-746-9039
Mailing Address - Fax:
Practice Address - Street 1:320 WARNER DR
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-4441
Practice Address - Country:US
Practice Address - Phone:208-743-3523
Practice Address - Fax:208-746-8741
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10002079363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
R86287Medicare UPIN