Active NPI
Charmaine Clark
- Doula
- Moline, IL
National Provider Identifier
1306671920
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Doula
- Practice address
- 524 15TH St
Moline, IL 61265-2170 - Phone
- (309) 506-0255
- NPI assigned
- Sep 4, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Doula | 374J00000X | Primary |
Addresses
Primary practice location
524 15TH St
Moline, IL 61265-2170
Mailing address
524 15TH St
Moline, IL 61265-2170
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1725408000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1725408000000",
"number": "1306671920",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "524 15TH ST",
"city": "MOLINE",
"state": "IL",
"postal_code": "612652170"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "524 15TH ST",
"city": "MOLINE",
"state": "IL",
"postal_code": "612652170",
"telephone_number": "309-506-0255"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "CHARMAINE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-09-04",
"last_updated": "2024-09-04",
"certification_date": "2024-09-04",
"status": "A"
},
"taxonomies": [
{
"code": "374J00000X",
"taxonomy_group": "",
"desc": "Doula",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Moline, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.