=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235062423
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHEILA CHAMBLAIN PMHNP-BC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/05/2026
-----------------------------------------------------
Last Update Date | 06/05/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | PO BOX 1459
-----------------------------------------------------
City | MINNEAPOLIS
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55440-1459
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 612-851-4041
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5592 NW WESLEY RD
-----------------------------------------------------
City | PORT ST LUCIE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34986-4201
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 612-851-4041
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | APRN11047010
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------