Healthcare Provider Details

I. General information

NPI: 1861396079
Provider Name (Legal Business Name): RUSHIE T CHAMBLEE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2026
Last Update Date: 10/03/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 NEW LONDON TPKE
NORWICH CT
06360-2645
US

IV. Provider business mailing address

108 NEW LONDON TPKE
NORWICH CT
06360-2645
US

V. Phone/Fax

Practice location:
  • Phone: 860-889-3052
  • Fax:
Mailing address:
  • Phone: 860-889-3052
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number18487
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: