Provider Demographics
NPI:1144592130
Name:CHAMBERLAIN, CHRYSTAL
Entity Type:Individual
Prefix:
First Name:CHRYSTAL
Middle Name:
Last Name:CHAMBERLAIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:196 ARROWHEAD DR STE 6
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:WY
Mailing Address - Zip Code:82930-8752
Mailing Address - Country:US
Mailing Address - Phone:307-789-4224
Mailing Address - Fax:307-789-4225
Practice Address - Street 1:196 ARROWHEAD DR STE 6
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:WY
Practice Address - Zip Code:82930-8752
Practice Address - Country:US
Practice Address - Phone:307-789-4224
Practice Address - Fax:307-789-4225
Is Sole Proprietor?:No
Enumeration Date:2012-02-06
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker