Healthcare Provider Details

I. General information

NPI: 1154423713
Provider Name (Legal Business Name): KATHRYN ANNE CHAMBERS MSNANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2006
Last Update Date: 01/14/2021
Certification Date: 01/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 SAINT ANTHONY ST
AUBURN NY
13021-4525
US

IV. Provider business mailing address

5697 W LAKE RD
AUBURN NY
13021-9702
US

V. Phone/Fax

Practice location:
  • Phone: 315-253-0351
  • Fax:
Mailing address:
  • Phone: 315-253-0924
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF301829-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: