Healthcare Provider Details

I. General information

NPI: 1427137769
Provider Name (Legal Business Name): CAROL CHAMBLIN RN, APN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 TYLER RD STE L2
ST CHARLES IL
60174-3363
US

IV. Provider business mailing address

525 TYLER RD STE L2
ST CHARLES IL
60174-3363
US

V. Phone/Fax

Practice location:
  • Phone: 630-513-1101
  • Fax: 630-232-4590
Mailing address:
  • Phone: 630-513-1101
  • Fax: 630-232-4590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: