Provider Demographics
NPI:1235160912
Name:CHAMBERLAIN, MOLLIE D (FNPC)
Entity Type:Individual
Prefix:
First Name:MOLLIE
Middle Name:D
Last Name:CHAMBERLAIN
Suffix:
Gender:F
Credentials:FNPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:93 OLD COUNTY RD
Mailing Address - Street 2:
Mailing Address - City:LYNDONVILLE
Mailing Address - State:VT
Mailing Address - Zip Code:05851-8417
Mailing Address - Country:US
Mailing Address - Phone:802-626-5983
Mailing Address - Fax:
Practice Address - Street 1:DARTMOUTH HITCHCOCK CLINIC
Practice Address - Street 2:195 INDUSTRIAL PKWY
Practice Address - City:LYNDON
Practice Address - State:VT
Practice Address - Zip Code:05849
Practice Address - Country:US
Practice Address - Phone:802-748-9501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT101-0008367363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1002901Medicaid
VT1002901Medicaid
VTP21834Medicare UPIN