Provider Demographics
NPI:1659899102
Name:CHIFAMBA, AVEREE (CD(DONA), CPM, LM)
Entity Type:Individual
Prefix:
First Name:AVEREE
Middle Name:
Last Name:CHIFAMBA
Suffix:
Gender:F
Credentials:CD(DONA), CPM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 W MENDENHALL ST STE B
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-3411
Mailing Address - Country:US
Mailing Address - Phone:406-599-3153
Mailing Address - Fax:
Practice Address - Street 1:411 W MENDENHALL ST STE B
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-3411
Practice Address - Country:US
Practice Address - Phone:406-599-3153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTAHC-MID-LIC-2337174N00000X, 176B00000X
MT11661374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No174N00000XOther Service ProvidersLactation Consultant, Non-RN
No374J00000XNursing Service Related ProvidersDoula
Provider Identifiers
StateIdentifier IDID TypeIssuer
1444620OtherBAI DOULA
11661OtherDONA
MTACH-MID-LIC-2337OtherCPM, LM