Provider Demographics
NPI:1861778912
Name:CHANCELLOR-CHECKETTS, DANIELLE MARIE (CPM-LDEM)
Entity type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:MARIE
Last Name:CHANCELLOR-CHECKETTS
Suffix:
Gender:F
Credentials:CPM-LDEM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8325 N. 3600 W.
Mailing Address - Street 2:
Mailing Address - City:HONEYVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84314
Mailing Address - Country:US
Mailing Address - Phone:801-643-0604
Mailing Address - Fax:435-723-0605
Practice Address - Street 1:8325 N. 3600 W.
Practice Address - Street 2:
Practice Address - City:HONEYVILLE
Practice Address - State:UT
Practice Address - Zip Code:84134
Practice Address - Country:US
Practice Address - Phone:801-643-0604
Practice Address - Fax:435-723-0605
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-02
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
175M00000X
UT84959431-3400176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No175M00000XOther Service ProvidersMidwife, Lay