Provider Demographics
NPI:1013395706
Name:CHAMBERLAIN, JOSEPH C (CRNA)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:C
Last Name:CHAMBERLAIN
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 844183
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-4183
Mailing Address - Country:US
Mailing Address - Phone:855-654-5262
Mailing Address - Fax:817-735-0016
Practice Address - Street 1:202 PROSPECT DR
Practice Address - Street 2:
Practice Address - City:GLENDIVE
Practice Address - State:MT
Practice Address - Zip Code:59330-1999
Practice Address - Country:US
Practice Address - Phone:406-345-3306
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-13
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXIN PROCESS367500000X
MT175567367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered