Provider Demographics
NPI:1710419676
Name:CHAMBERLAIN, NICOLE (IBCLC)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:CHAMBERLAIN
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1214 ALDER ST
Mailing Address - Street 2:
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-1871
Mailing Address - Country:US
Mailing Address - Phone:239-989-4955
Mailing Address - Fax:
Practice Address - Street 1:1214 ALDER ST
Practice Address - Street 2:
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-1871
Practice Address - Country:US
Practice Address - Phone:239-989-4955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-30
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN