Provider Demographics
NPI:1831522085
Name:CHAMBERS, NIKKOLE RENEE (FPN)
Entity type:Individual
Prefix:
First Name:NIKKOLE
Middle Name:RENEE
Last Name:CHAMBERS
Suffix:
Gender:F
Credentials:FPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 E CULVER RD
Mailing Address - Street 2:
Mailing Address - City:KNOX
Mailing Address - State:IN
Mailing Address - Zip Code:46534-2241
Mailing Address - Country:US
Mailing Address - Phone:574-772-7400
Mailing Address - Fax:574-772-0299
Practice Address - Street 1:104 E CULVER RD
Practice Address - Street 2:
Practice Address - City:KNOX
Practice Address - State:IN
Practice Address - Zip Code:46534-2241
Practice Address - Country:US
Practice Address - Phone:574-772-7400
Practice Address - Fax:574-772-0299
Is Sole Proprietor?:No
Enumeration Date:2013-08-12
Last Update Date:2017-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28156859A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily