Healthcare Provider Details

I. General information

NPI: 1295710572
Provider Name (Legal Business Name): NANCY JO CHAMBERLAIN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/09/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NAVAL HOSPITAL, CAMP PENDLETON BLDG H100
CAMP PENDLETON CA
92055
US

IV. Provider business mailing address

1617 AVENIDA DE NOG
FALLBROOK CA
92028-4655
US

V. Phone/Fax

Practice location:
  • Phone: 760-725-1571
  • Fax:
Mailing address:
  • Phone: 760-728-2166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WI0600X
TaxonomyInfection Control Registered Nurse
License Number333879
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: