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General NPI Number Information
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NPI Number | 1831997360
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Entity Type | Individual
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Provider Name | CHANNON MICHELLE LEE CAMPBELL CNM, MSN, RN, MPH
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Gender | Female
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Dates
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Enumeration Date | 03/03/2025
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Last Update Date | 06/25/2025
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Provider Practice Location Address
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Address Line | 966 W 21ST ST
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City | CHICAGO
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State | IL
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Zip | 60608-4511
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Country | US
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Telephone | 773-254-1400
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Fax |
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Provider Business Mailing Address
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Address Line | 1595 ATWATER ST APT 102
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City | DETROIT
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State | MI
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Zip | 48207-4075
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Country | US
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Telephone | 616-745-8300
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Fax |
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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 | 4704357340
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 367A00000X
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Taxonomy Name | Advanced Practice Midwife
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License Number | 209032600
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License Number State | IL
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