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General NPI Number Information
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NPI Number | 1316556277
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Entity Type | Individual
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Provider Name | CARISSA ELLEN CHAMBERLAIN CPM, LM
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Gender | Female
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Dates
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Enumeration Date | 07/27/2020
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Last Update Date | 07/27/2020
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Provider Practice Location Address
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Address Line | 505 BOYDSTUN ST
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City | MCCALL
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State | ID
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Zip | 83638-3403
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Country | US
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Telephone | 208-615-2273
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Fax | 208-630-6303
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Provider Business Mailing Address
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Address Line | 505 BOYDSTUN ST
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City | MCCALL
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State | ID
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Zip | 83638-3403
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Country | US
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Telephone | 208-615-2273
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Fax | 208-630-6303
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 176B00000X
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Taxonomy Name | Midwife
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License Number | MID-105
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License Number State | ID
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