Healthcare Provider Details

I. General information

NPI: 1912976952
Provider Name (Legal Business Name): RACHAEL L CHAMBERS DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 05/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11134 NORTH HWY 77
HAYWARD WI
54843
US

IV. Provider business mailing address

11134 NORTH HWY 77
HAYWARD WI
54843
US

V. Phone/Fax

Practice location:
  • Phone: 715-634-5505
  • Fax:
Mailing address:
  • Phone: 715-634-5505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number47631
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number50778-21
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: