MEDICARE: DIANE CHAMBERLIN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	365015	CA
2	363LF0000X	Family Nurse Practitioner	4262	CA
3	363LW0102X	Women's Health Nurse Practitioner	4262	CA

General Provider Information

NPI Number	:	1316010374
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANE CHAMBERLIN

Provider Business Mailing Address
First Line	:	4 EMBARCADERO CTR
Second Line	:	LOBBY LEVEL
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94111-4106
Country	:	US
Telephone Number	:	415-529-4566
Fax Number	:	415-291-0489

Provider Business Practice Location Address
First Line	:	4 EMBARCADERO CTR
Second Line	:	LOBBY LEVEL
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94111-4106
Country	:	US
Telephone Number	:	415-529-4566
Fax Number	:	415-291-0489

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/16/2006
Last Update Date	:	12/17/2014

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Directions to “ DIANE CHAMBERLIN ” Practice Location

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