Healthcare Provider Details

I. General information

NPI: 1457222499
Provider Name (Legal Business Name): CEIERA MICHELLE CHAMBERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2025
Last Update Date: 09/15/2025
Certification Date: 09/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17553 W YOUNG ST
SURPRISE AZ
85388-3128
US

IV. Provider business mailing address

17553 W YOUNG ST
SURPRISE AZ
85388-3128
US

V. Phone/Fax

Practice location:
  • Phone: 623-670-0234
  • Fax:
Mailing address:
  • Phone: 623-670-0234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number224255
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: