Provider Demographics
NPI:1487363552
Name:CHAPPLE, MIA M (APRN, CNP)
Entity type:Individual
Prefix:
First Name:MIA
Middle Name:M
Last Name:CHAPPLE
Suffix:
Gender:
Credentials:APRN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:544 LAKEVIEW PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:VERNON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60061-1826
Mailing Address - Country:US
Mailing Address - Phone:503-714-3582
Mailing Address - Fax:833-547-1927
Practice Address - Street 1:1360 E IRVING PARK RD
Practice Address - Street 2:
Practice Address - City:STREAMWOOD
Practice Address - State:IL
Practice Address - Zip Code:60107-3202
Practice Address - Country:US
Practice Address - Phone:630-736-2743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-17
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61500190363LP0808X
WI13443-33363LP0808X
OR10003531363LP0808X
IL209026408363LP0808X, 363LP0808X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health