Basic Information
| Provider Information | |||||||||
| NPI: | 1174740831 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHAPMAN | ||||||||
| FirstName: | LARRY | ||||||||
| MiddleName: | EDWARD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 600 W RIDGE RD | ||||||||
| Address2: | |||||||||
| City: | WYTHEVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 243821044 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2762280200 | ||||||||
| FaxNumber: | 2762280379 | ||||||||
| Practice Location | |||||||||
| Address1: | 600 W RIDGE RD | ||||||||
| Address2: | |||||||||
| City: | WYTHEVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 24382 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2762280200 | ||||||||
| FaxNumber: | 2762280379 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2007 | ||||||||
| LastUpdateDate: | 06/19/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 0024059126 | VA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.