Provider Demographics
NPI:1609657998
Name:CHAMBERLAIN, DARCIE LYN (APRN)
Entity Type:Individual
Prefix:
First Name:DARCIE
Middle Name:LYN
Last Name:CHAMBERLAIN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1149 N GRAYSON PKWY
Mailing Address - Street 2:
Mailing Address - City:BLANDING
Mailing Address - State:UT
Mailing Address - Zip Code:84511-2110
Mailing Address - Country:US
Mailing Address - Phone:435-979-5095
Mailing Address - Fax:
Practice Address - Street 1:1149 N GRAYSON PKWY
Practice Address - Street 2:
Practice Address - City:BLANDING
Practice Address - State:UT
Practice Address - Zip Code:84511-2110
Practice Address - Country:US
Practice Address - Phone:435-979-5095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-11
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6719693-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily