Provider Demographics
NPI:1255984514
Name:CHAPMAN, BRANDON CHASE
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:CHASE
Last Name:CHAPMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33495 FOLLMAN WAY
Mailing Address - Street 2:
Mailing Address - City:LAKE ELSINORE
Mailing Address - State:CA
Mailing Address - Zip Code:92530-6103
Mailing Address - Country:US
Mailing Address - Phone:714-618-1117
Mailing Address - Fax:
Practice Address - Street 1:33495 FOLLMAN WAY
Practice Address - Street 2:
Practice Address - City:LAKE ELSINORE
Practice Address - State:CA
Practice Address - Zip Code:92530-6103
Practice Address - Country:US
Practice Address - Phone:714-618-1117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-16
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95196840163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse