Provider Demographics
NPI:1427434596
Name:DAHMER, CAITLIN MARIE (CNM)
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:MARIE
Last Name:DAHMER
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2568 RAVINE WAY
Mailing Address - Street 2:
Mailing Address - City:STEVENSVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49127-9770
Mailing Address - Country:US
Mailing Address - Phone:269-930-2781
Mailing Address - Fax:
Practice Address - Street 1:3750 W OGDEN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60623-2426
Practice Address - Country:US
Practice Address - Phone:269-930-2781
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-30
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MICNM2672367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife