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General NPI Number Information
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NPI Number | 1982016945
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Entity Type | Individual
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Provider Name | NICOLE CHAMBERLAIN
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Gender | Female
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Dates
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Enumeration Date | 05/27/2014
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Last Update Date | 01/20/2017
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Provider Practice Location Address
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Address Line | 1201 EUBANK BLVD NE STE 2
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City | ALBUQUERQUE
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State | NM
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Zip | 87112-5300
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Country | US
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Telephone | 505-280-5944
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Fax | 505-298-7724
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Provider Business Mailing Address
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Address Line | 4918 ARROYO CHAMISA RD NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87111-3716
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Country | US
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Telephone | 505-280-5944
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172M00000X
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Taxonomy Name | Mechanotherapist
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License Number | 7736
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License Number State | NM
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