Provider Demographics
NPI:1174397749
Name:CHAMBERS, STEPHANIE HATHCOCK (RN)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:HATHCOCK
Last Name:CHAMBERS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:STEPHANIE
Other - Middle Name:ANN
Other - Last Name:HATHCOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:415 GREY EAGLE DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919-1717
Mailing Address - Country:US
Mailing Address - Phone:719-321-1274
Mailing Address - Fax:
Practice Address - Street 1:415 GREY EAGLE DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80919-1717
Practice Address - Country:US
Practice Address - Phone:719-321-1274
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-14
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN.0169605163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse