Provider Demographics
NPI:1427137769
Name:CHAMBLIN, CAROL (RN, APN, IBCLC)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:CHAMBLIN
Suffix:
Gender:F
Credentials:RN, APN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 TYLER RD STE L2
Mailing Address - Street 2:
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-3363
Mailing Address - Country:US
Mailing Address - Phone:630-513-1101
Mailing Address - Fax:630-232-4590
Practice Address - Street 1:525 TYLER RD STE L2
Practice Address - Street 2:
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-3363
Practice Address - Country:US
Practice Address - Phone:630-513-1101
Practice Address - Fax:630-232-4590
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL163WL0100X, 364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
Not Answered364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist