Healthcare Provider Details

I. General information

NPI: 1477271211
Provider Name (Legal Business Name): RYAN MAITE CHAMBERS CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2022
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 CENTRAL AVE NW STE 3
ALBUQUERQUE NM
87105-1630
US

IV. Provider business mailing address

53 VIA ENTRADA
SANDIA PARK NM
87047-9681
US

V. Phone/Fax

Practice location:
  • Phone: 505-508-1739
  • Fax:
Mailing address:
  • Phone: 505-301-4773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number69418
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: