Provider Demographics
NPI:1952677809
Name:CHAMBERS, ALYCIA JEANNE (CPM, RM)
Entity Type:Individual
Prefix:MRS
First Name:ALYCIA
Middle Name:JEANNE
Last Name:CHAMBERS
Suffix:
Gender:F
Credentials:CPM, RM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:459 NORTH ALDER STREET
Mailing Address - Street 2:PO BOX 895
Mailing Address - City:CRESTONE
Mailing Address - State:CO
Mailing Address - Zip Code:81131-0895
Mailing Address - Country:US
Mailing Address - Phone:719-256-5572
Mailing Address - Fax:
Practice Address - Street 1:459 N. ALDER ST.
Practice Address - Street 2:
Practice Address - City:CRESTONE
Practice Address - State:CO
Practice Address - Zip Code:81131-0895
Practice Address - Country:US
Practice Address - Phone:719-256-5572
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-26
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO133176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife