Provider Demographics
NPI:1750639266
Name:CHAMBERS, RICQUEL PHILLIP (LPN)
Entity Type:Individual
Prefix:
First Name:RICQUEL
Middle Name:PHILLIP
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 1:3210 AVENUE H
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-3256
Mailing Address - Country:US
Mailing Address - Phone:347-789-3291
Mailing Address - Fax:
Practice Address - Street 1:3210 AVENUE H
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210-3256
Practice Address - Country:US
Practice Address - Phone:347-789-3291
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-15
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY257316164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse