Provider Demographics
NPI:1144039173
Name:CHAMBERS, MARISA JEAN
Entity type:Individual
Prefix:
First Name:MARISA
Middle Name:JEAN
Last Name:CHAMBERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 BENHAM ST # 1
Mailing Address - Street 2:
Mailing Address - City:PENN YAN
Mailing Address - State:NY
Mailing Address - Zip Code:14527-1211
Mailing Address - Country:US
Mailing Address - Phone:315-454-7157
Mailing Address - Fax:
Practice Address - Street 1:102 BENHAM ST # 1
Practice Address - Street 2:
Practice Address - City:PENN YAN
Practice Address - State:NY
Practice Address - Zip Code:14527-1211
Practice Address - Country:US
Practice Address - Phone:315-454-7157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-03
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNY000426685E376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide