Basic Information
| Provider Information | |||||||||
| NPI: | 1154334712 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHAMBERS | ||||||||
| FirstName: | LAUREL | ||||||||
| MiddleName: | G. | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | P.A.-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1208 6TH AVE | ||||||||
| Address2: | P.O. BOX 698 | ||||||||
| City: | SUPERIOR | ||||||||
| State: | MT | ||||||||
| PostalCode: | 598729618 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4068224278 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1208 6TH AVE | ||||||||
| Address2: | |||||||||
| City: | SUPERIOR | ||||||||
| State: | MT | ||||||||
| PostalCode: | 598729618 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4068224278 | ||||||||
| FaxNumber: | 4068224912 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/14/2006 | ||||||||
| LastUpdateDate: | 12/27/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 249 | MT | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
ID Information
| ID | Type | State | Issuer | Description | 0436410 | 05 | MT | MEDICAID | 93073 | 01 | MT | BC/BS OF MONTANA | OTHER |