Healthcare Provider Details

I. General information

NPI: 1609236942
Provider Name (Legal Business Name): CHISULA CHAMBERS MPH, LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/29/2016
Last Update Date: 02/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27026 47TH PL S APT D204
KENT WA
98032-6251
US

IV. Provider business mailing address

27026 47TH PL S APT D204
KENT WA
98032-6251
US

V. Phone/Fax

Practice location:
  • Phone: 206-302-9808
  • Fax:
Mailing address:
  • Phone: 206-302-9808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberLP00058810
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLP00058810
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: