Provider Demographics
NPI:1053074252
Name:CHAMBERLAIN, ANNA (BSN, RN, IBCLC, CCCE)
Entity Type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:
Last Name:CHAMBERLAIN
Suffix:
Gender:F
Credentials:BSN, RN, IBCLC, CCCE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:278 SOUTHLAND DR STE 150
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-1954
Mailing Address - Country:US
Mailing Address - Phone:859-582-6441
Mailing Address - Fax:
Practice Address - Street 1:278 SOUTHLAND DR STE 150
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-1954
Practice Address - Country:US
Practice Address - Phone:859-582-6441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-15
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1122123163W00000X, 163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No163W00000XNursing Service ProvidersRegistered Nurse