=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831422617
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KATHLEEN MARGARET CHAMBERLAIN RN, BSN, CDE
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/11/2009
-----------------------------------------------------
Last Update Date | 09/11/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 200 WEST HOSPITAL DRIVE
-----------------------------------------------------
City | WHITERIVER
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85941
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 928-338-4911
-----------------------------------------------------
Fax | 928-338-3522
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 860
-----------------------------------------------------
City | WHITERIVER
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85941-0860
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 928-338-4911
-----------------------------------------------------
Fax | 928-338-3522
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | 1610272
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 163WD0400X
-----------------------------------------------------
Taxonomy Name | Diabetes Educator Registered Nurse
-----------------------------------------------------
License Number | CDE 2091-0069
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------