Healthcare Provider Details

I. General information

NPI: 1417899139
Provider Name (Legal Business Name): MADELINE CHAMBERLAIN PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2026
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1345 W 1600 N STE 200
OREM UT
84057-2431
US

IV. Provider business mailing address

1345 W 1600 N STE 200
OREM UT
84057-2431
US

V. Phone/Fax

Practice location:
  • Phone: 385-442-6555
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number10966258-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: