Provider Demographics
NPI:1891086351
Name:CHAMBERLAIN, CAROL J (RN)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:J
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 1:412 MOONINGS COVE DRIVE
Mailing Address - Street 2:
Mailing Address - City:TARPON
Mailing Address - State:FL
Mailing Address - Zip Code:34689
Mailing Address - Country:US
Mailing Address - Phone:727-946-0956
Mailing Address - Fax:
Practice Address - Street 1:412 MOONINGS COVE DRIVE
Practice Address - Street 2:
Practice Address - City:TARPON
Practice Address - State:FL
Practice Address - Zip Code:34689
Practice Address - Country:US
Practice Address - Phone:727-946-0956
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-02
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK26564163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK26564OtherSTATE OF ALASKA