Provider Demographics
NPI:1710312970
Name:CHAMBERS, BRITTANY J (PA-C)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:J
Last Name:CHAMBERS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:833 S IOWA ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:DODGEVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53533-1900
Mailing Address - Country:US
Mailing Address - Phone:608-935-3301
Mailing Address - Fax:680-935-3823
Practice Address - Street 1:833 S IOWA ST
Practice Address - Street 2:SUITE 102
Practice Address - City:DODGEVILLE
Practice Address - State:WI
Practice Address - Zip Code:53533-1900
Practice Address - Country:US
Practice Address - Phone:608-935-3301
Practice Address - Fax:680-935-3823
Is Sole Proprietor?:No
Enumeration Date:2013-09-06
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3219-23363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1710312970Medicaid
WIP01530350OtherRAILROAD MEDICARE
WI1710312970Medicaid