Provider Demographics
NPI:1710187182
Name:CHAMBERLAIN, MICHELLE NICOLE (RN)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:NICOLE
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 1:2504 OLINVILLE AVE
Mailing Address - Street 2:APT # 2B
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-7452
Mailing Address - Country:US
Mailing Address - Phone:718-547-9743
Mailing Address - Fax:
Practice Address - Street 1:2504 OLINVILLE AVE
Practice Address - Street 2:APT # 2B
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-7452
Practice Address - Country:US
Practice Address - Phone:718-547-9743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-23
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY443694-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01789977Medicaid