Provider Demographics
NPI:1699008037
Name:CHAMBERS, DEWITA LATRICE (LPN)
Entity Type:Individual
Prefix:MS
First Name:DEWITA
Middle Name:LATRICE
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 1:1434 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53402-5031
Mailing Address - Country:US
Mailing Address - Phone:262-822-6474
Mailing Address - Fax:
Practice Address - Street 1:1434 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53402-5031
Practice Address - Country:US
Practice Address - Phone:262-822-6474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-17
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI308069-31164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse