Provider Demographics
NPI:1316010374
Name:CHAMBERLIN, DIANE
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:CHAMBERLIN
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 1:4 EMBARCADERO CTR
Mailing Address - Street 2:LOBBY LEVEL
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94111-4106
Mailing Address - Country:US
Mailing Address - Phone:415-529-4566
Mailing Address - Fax:415-291-0489
Practice Address - Street 1:4 EMBARCADERO CTR
Practice Address - Street 2:LOBBY LEVEL
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94111-4106
Practice Address - Country:US
Practice Address - Phone:415-529-4566
Practice Address - Fax:415-291-0489
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2014-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA365015163W00000X
CA4262363LF0000X, 363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health