Provider Demographics
NPI:1730415720
Name:CHAMBERLAIN, SONYA K (LM, CPM)
Entity type:Individual
Prefix:
First Name:SONYA
Middle Name:K
Last Name:CHAMBERLAIN
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 KINGWOOD ST STE 121
Mailing Address - Street 2:
Mailing Address - City:BRAINERD
Mailing Address - State:MN
Mailing Address - Zip Code:56401-3400
Mailing Address - Country:US
Mailing Address - Phone:218-821-1426
Mailing Address - Fax:218-260-4321
Practice Address - Street 1:1001 KINGWOOD ST STE 121
Practice Address - Street 2:
Practice Address - City:BRAINERD
Practice Address - State:MN
Practice Address - Zip Code:56401-3400
Practice Address - Country:US
Practice Address - Phone:218-821-1426
Practice Address - Fax:218-260-4321
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-26
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1039OtherMINNESOTA BOARD OF MEDICAL PRACTICE, LICENSING