Healthcare Provider Details

I. General information

NPI: 1245917202
Provider Name (Legal Business Name): TAYLOR CHAMBERLAIN DNP, CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2023
Last Update Date: 06/30/2023
Certification Date: 06/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

845 S DAMEN AVE # MC802
CHICAGO IL
60612-3727
US

IV. Provider business mailing address

47 US HIGHWAY 51
OCONEE IL
62553-4193
US

V. Phone/Fax

Practice location:
  • Phone: 312-996-7800
  • Fax:
Mailing address:
  • Phone: 217-722-1988
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: