Provider Demographics
NPI:1790759611
Name:CHAMBERS, CARROL C (NP)
Entity Type:Individual
Prefix:MRS
First Name:CARROL
Middle Name:C
Last Name:CHAMBERS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4211 MEDICAL CENTER DRIVE
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13066
Mailing Address - Country:US
Mailing Address - Phone:315-329-0210
Mailing Address - Fax:315-329-0215
Practice Address - Street 1:4211 MEDICAL CENTER DRIVE
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NY
Practice Address - Zip Code:13066
Practice Address - Country:US
Practice Address - Phone:315-329-0210
Practice Address - Fax:315-329-0215
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF3009361363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02185000Medicaid
NY02185000Medicaid
NYR93256Medicare UPIN
R93256Medicare UPIN