Provider Demographics
NPI:1992744171
Name:CHAMBERLAIN, DONALD E (CRNA)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:E
Last Name:CHAMBERLAIN
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 440167
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37244-0167
Mailing Address - Country:US
Mailing Address - Phone:615-620-2320
Mailing Address - Fax:615-620-2323
Practice Address - Street 1:401 SEWELL DR
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:TN
Practice Address - Zip Code:38583-1223
Practice Address - Country:US
Practice Address - Phone:615-620-2320
Practice Address - Fax:615-620-2323
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN 011520367500000X
TNRN047828163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN01069113OtherAMERIGROUP TENNCARE - NON PAR
TN4168754OtherBLUE CROSS/BLUE SHIELD OF TN - AERO
TN3601605Medicaid
WA9638982Medicaid
TN4168754OtherBLUE CROSS/BLUE SHIELD OF TN - AERO
TN3601605Medicaid
TN3601605Medicare PIN