Provider Demographics
NPI:1407216286
Name:CHILDRESS, CAMBER
Entity Type:Individual
Prefix:
First Name:CAMBER
Middle Name:
Last Name:CHILDRESS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1970 W 7800 S
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84088-4025
Mailing Address - Country:US
Mailing Address - Phone:801-506-6695
Mailing Address - Fax:801-515-5441
Practice Address - Street 1:1970 W 7800 S
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-4025
Practice Address - Country:US
Practice Address - Phone:801-506-6695
Practice Address - Fax:801-515-5441
Is Sole Proprietor?:No
Enumeration Date:2016-03-07
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist