Provider Demographics
NPI:1710057419
Name:CHAMBERLAIN, ELAINE R (RN)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:R
Last Name:CHAMBERLAIN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 PLEASANT AVE
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075-4720
Mailing Address - Country:US
Mailing Address - Phone:716-649-8064
Mailing Address - Fax:716-648-0666
Practice Address - Street 1:97 S BUFFALO ST
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:NY
Practice Address - Zip Code:14075-6212
Practice Address - Country:US
Practice Address - Phone:716-648-0650
Practice Address - Fax:716-648-0666
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5825418163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00671792Medicare ID - Type UnspecifiedGROUP MEDICAID #