Provider Demographics
NPI:1952522823
Name:CHAMBERLAIN, CHRISTY LYNN
Entity Type:Individual
Prefix:MRS
First Name:CHRISTY
Middle Name:LYNN
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 1:22910 E APPLEWAY
Mailing Address - Street 2:SUITE 3
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-8606
Mailing Address - Country:US
Mailing Address - Phone:509-891-2856
Mailing Address - Fax:509-891-0125
Practice Address - Street 1:22910 E APPLE WAY
Practice Address - Street 2:SUITE 3
Practice Address - City:LIBERTY LAKE
Practice Address - State:WA
Practice Address - Zip Code:99019-8605
Practice Address - Country:US
Practice Address - Phone:509-891-2856
Practice Address - Fax:509-891-0125
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA602 016 543332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9052374Medicaid
WA71-0864746OtherTAX ID
WA71-0864746OtherTAX ID