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General NPI Number Information
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NPI Number | 1568846764
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Entity Type | Individual
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Provider Name | JACQUELYN MCMILLIAN-BOHLER CNM
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Gender | Female
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Dates
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Enumeration Date | 07/17/2015
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Last Update Date | 07/23/2015
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Provider Practice Location Address
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Address Line | 401 E CHESTNUT ST STE 410
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City | LOUISVILLE
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State | KY
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Zip | 40202-5700
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Country | US
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Telephone | 502-588-4400
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Fax | 502-588-4401
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Provider Business Mailing Address
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Address Line | PO BOX 909
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City | LOUISVILLE
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State | KY
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Zip | 40201-0909
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Country | US
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Telephone | 502-588-0329
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Fax | 502-588-0329
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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 | 367A00000X
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Taxonomy Name | Advanced Practice Midwife
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License Number | 3004766
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License Number State | KY
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