Provider Demographics
NPI:1255187811
Name:CHAMBERLAIN, SANDRA JANE
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:JANE
Last Name:CHAMBERLAIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1036 HIGHWAY 64 E
Mailing Address - Street 2:
Mailing Address - City:ALMA
Mailing Address - State:AR
Mailing Address - Zip Code:72921-6807
Mailing Address - Country:US
Mailing Address - Phone:479-632-3813
Mailing Address - Fax:
Practice Address - Street 1:1036 HIGHWAY 64 E
Practice Address - Street 2:
Practice Address - City:ALMA
Practice Address - State:AR
Practice Address - Zip Code:72921-6807
Practice Address - Country:US
Practice Address - Phone:479-632-3813
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-25
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARL025614164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR925076991OtherSCHOOL NURSE