Provider Demographics
NPI:1023077005
Name:CHAPPELL, HEATHER ELIZABETH (DNP)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:ELIZABETH
Last Name:CHAPPELL
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:ELIZABETH
Other - Last Name:KRULL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DNP
Mailing Address - Street 1:100 MICHIGAN ST NE # MC845
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2560
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:80 68TH ST SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49548-6980
Practice Address - Country:US
Practice Address - Phone:616-391-8242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704325294363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
INM400059853Medicare PIN
INQ32540Medicare UPIN
IN058490OOMedicare ID - Type Unspecified
IN058490OOMedicare ID - Type Unspecified
INP00333382OtherMEDICARE - RAILROAD
IN200278300Medicaid
OH2518592Medicaid