Provider Demographics
NPI:1114529666
Name:CHAMBLEE, ELLEN JANET (RN, IBCLC)
Entity Type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:JANET
Last Name:CHAMBLEE
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3615 BLACKBURN RD NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-3207
Mailing Address - Country:US
Mailing Address - Phone:330-583-4228
Mailing Address - Fax:330-451-5728
Practice Address - Street 1:3615 BLACKBURN RD NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-3207
Practice Address - Country:US
Practice Address - Phone:330-583-4228
Practice Address - Fax:330-451-5728
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-10
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHL-149877163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant