Healthcare Provider Details

I. General information

NPI: 1861778912
Provider Name (Legal Business Name): DANIELLE MARIE CHANCELLOR-CHECKETTS CPM-LDEM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2011
Last Update Date: 08/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8325 N. 3600 W.
HONEYVILLE UT
84134
US

IV. Provider business mailing address

8325 N. 3600 W.
HONEYVILLE UT
84314
US

V. Phone/Fax

Practice location:
  • Phone: 801-643-0604
  • Fax: 435-723-0605
Mailing address:
  • Phone: 801-643-0604
  • Fax: 435-723-0605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175M00000X
TaxonomyLay Midwife
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number84959431-3400
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: