Provider Demographics
NPI:1649394719
Name:CHAMBERLAIN, REBECCA SUE (NP)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:SUE
Last Name:CHAMBERLAIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 9007
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22906-9007
Mailing Address - Country:US
Mailing Address - Phone:434-980-6140
Mailing Address - Fax:434-972-4266
Practice Address - Street 1:LEE ST FL 2
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22908-0001
Practice Address - Country:US
Practice Address - Phone:434-243-6828
Practice Address - Fax:434-982-3885
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2010-10-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0024166809363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1649394719Medicaid
VA1649394719Medicaid