Provider Demographics
NPI:1982588059
Name:CHAMBERLAIN, TANISHA MAI
Entity type:Individual
Prefix:
First Name:TANISHA
Middle Name:MAI
Last Name:CHAMBERLAIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8418 E 300 N
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:IN
Mailing Address - Zip Code:47558-5210
Mailing Address - Country:US
Mailing Address - Phone:812-486-6938
Mailing Address - Fax:
Practice Address - Street 1:8418 E 300 N
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:IN
Practice Address - Zip Code:47558-5210
Practice Address - Country:US
Practice Address - Phone:812-486-6938
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-02
Last Update Date:2025-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program