Healthcare Provider Details

I. General information

NPI: 1316010374
Provider Name (Legal Business Name): DIANE CHAMBERLIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 12/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 EMBARCADERO CTR LOBBY LEVEL
SAN FRANCISCO CA
94111-4106
US

IV. Provider business mailing address

4 EMBARCADERO CTR LOBBY LEVEL
SAN FRANCISCO CA
94111-4106
US

V. Phone/Fax

Practice location:
  • Phone: 415-529-4566
  • Fax: 415-291-0489
Mailing address:
  • Phone: 415-529-4566
  • Fax: 415-291-0489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number365015
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4262
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number4262
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: