Provider Demographics
NPI:1831997360
Name:CAMPBELL, CHANNON MICHELLE LEE (CNM, MSN, RN, MPH)
Entity type:Individual
Prefix:
First Name:CHANNON
Middle Name:MICHELLE LEE
Last Name:CAMPBELL
Suffix:
Gender:
Credentials:CNM, MSN, RN, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1595 ATWATER ST APT 102
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48207-4075
Mailing Address - Country:US
Mailing Address - Phone:616-745-8300
Mailing Address - Fax:
Practice Address - Street 1:9021 JOSEPH CAMPAU ST
Practice Address - Street 2:
Practice Address - City:HAMTRAMCK
Practice Address - State:MI
Practice Address - Zip Code:48212-3726
Practice Address - Country:US
Practice Address - Phone:313-871-1926
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-03
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704357340367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife