Provider Demographics
NPI:1124261078
Name:CHAMBERS, WANDA GRACE (LPN)
Entity type:Individual
Prefix:MRS
First Name:WANDA
Middle Name:GRACE
Last Name:CHAMBERS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1313 COUNTY ROUTE 22
Mailing Address - Street 2:
Mailing Address - City:ALTMAR
Mailing Address - State:NY
Mailing Address - Zip Code:13302-3310
Mailing Address - Country:US
Mailing Address - Phone:315-298-8764
Mailing Address - Fax:
Practice Address - Street 1:1313 COUNTY ROUTE 22
Practice Address - Street 2:
Practice Address - City:ALTMAR
Practice Address - State:NY
Practice Address - Zip Code:13302-3310
Practice Address - Country:US
Practice Address - Phone:315-298-8764
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-08
Last Update Date:2009-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY236851-1164W00000X, 261QP0904X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No261QP0904XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, Federal