MEDICARE: LAKISHA CHAMBERS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	PN282633	PA

General Provider Information

NPI Number	:	1881986669
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAKISHA CHAMBERS

Provider Business Mailing Address
First Line	:	205 AVON RD
Second Line	:
City	:	CHERRY HILL
State	:	NJ
Zip	:	08034-1808
Country	:	US
Telephone Number	:	267-709-0688
Fax Number	:

Provider Business Practice Location Address
First Line	:	205 AVON RD
Second Line	:
City	:	CHERRY HILL
State	:	NJ
Zip	:	08034-1808
Country	:	US
Telephone Number	:	267-709-0688
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/11/2011
Last Update Date	:	05/11/2011

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