Healthcare Provider Details

I. General information

NPI: 1689533671
Provider Name (Legal Business Name): MAGGIE CHAMBERLAIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2026
Last Update Date: 01/16/2026
Certification Date: 01/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 ACOMA ST UNIT 316
DENVER CO
80204-4047
US

IV. Provider business mailing address

930 ACOMA ST UNIT 316
DENVER CO
80204-4047
US

V. Phone/Fax

Practice location:
  • Phone: 912-429-4274
  • Fax:
Mailing address:
  • Phone: 912-429-4274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number32100104
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86011246
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: