Healthcare Provider Details

I. General information

NPI: 1982588059
Provider Name (Legal Business Name): TANISHA MAI CHAMBERLAIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2014 CHADWICK DR
NEWBURGH IN
47630-7517
US

IV. Provider business mailing address

8418 E 300 N
MONTGOMERY IN
47558-5210
US

V. Phone/Fax

Practice location:
  • Phone: 812-486-6938
  • Fax: 812-356-6445
Mailing address:
  • Phone: 812-486-6938
  • Fax: 812-356-6445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71017039A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: