Healthcare Provider Details

I. General information

NPI: 1831997360
Provider Name (Legal Business Name): CHANNON MICHELLE LEE CAMPBELL CNM, MSN, RN, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2025
Last Update Date: 06/25/2025
Certification Date: 06/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

966 W 21ST ST
CHICAGO IL
60608-4511
US

IV. Provider business mailing address

1595 ATWATER ST APT 102
DETROIT MI
48207-4075
US

V. Phone/Fax

Practice location:
  • Phone: 773-254-1400
  • Fax:
Mailing address:
  • Phone: 616-745-8300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number4704357340
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number209032600
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: