Healthcare Provider Details

I. General information

NPI: 1215659784
Provider Name (Legal Business Name): MUMTAHENA CHAMBERS CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MUMTAHENA HANNAN

II. Dates (important events)

Enumeration Date: 09/13/2022
Last Update Date: 08/27/2025
Certification Date: 08/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 MANNING DR
CHAPEL HILL NC
27514-4220
US

IV. Provider business mailing address

5214 PICKFORD PL
DURHAM NC
27703-9286
US

V. Phone/Fax

Practice location:
  • Phone: 984-974-1000
  • Fax:
Mailing address:
  • Phone: 516-368-4531
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number310419
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number7994
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: