Provider Demographics
NPI:1639288830
Name:CHAMBERS, GERALDINE MARIE (PT)
Entity Type:Individual
Prefix:MS
First Name:GERALDINE
Middle Name:MARIE
Last Name:CHAMBERS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8028 35TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-4815
Mailing Address - Country:US
Mailing Address - Phone:206-524-0124
Mailing Address - Fax:206-524-0125
Practice Address - Street 1:8028 35TH AVE NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-4815
Practice Address - Country:US
Practice Address - Phone:206-524-0124
Practice Address - Fax:206-524-0125
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00002658174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WACH5461OtherREGENCE BLUESHIELD
WA8343089Medicaid
WA8343089Medicaid
WAP12209Medicare UPIN