Provider Demographics
NPI:1437128956
Name:CHAMBERLAIN, PATRICIA ANN (FNP)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:ANN
Last Name:CHAMBERLAIN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 FITCH ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14905-1634
Mailing Address - Country:US
Mailing Address - Phone:607-732-1515
Mailing Address - Fax:607-732-2234
Practice Address - Street 1:600 FITCH ST
Practice Address - Street 2:SUITE 206
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14905-1634
Practice Address - Country:US
Practice Address - Phone:607-732-1515
Practice Address - Fax:607-732-2234
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATP003656B363LF0000X
NYF331284-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAGU039851OtherMEDICARE GROUP
NY500018969OtherRR MEDICARE PIN
NYCC8362OtherRR MEDICARE GROUP
NY01630331Medicaid
PA820445N86Medicare UPIN
NY51323GMedicare ID - Type Unspecified
PAGU039851OtherMEDICARE GROUP