Provider Demographics
NPI:1427658459
Name:JAHN, CAMILYN (CPM, LM)
Entity type:Individual
Prefix:
First Name:CAMILYN
Middle Name:
Last Name:JAHN
Suffix:
Gender:F
Credentials:CPM, LM
Other - Prefix:
Other - First Name:CAMI
Other - Middle Name:
Other - Last Name:JAHN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CPM, LM
Mailing Address - Street 1:421 2ND AVE W
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-5805
Mailing Address - Country:US
Mailing Address - Phone:208-409-5393
Mailing Address - Fax:208-944-0552
Practice Address - Street 1:421 2ND AVE W
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-5805
Practice Address - Country:US
Practice Address - Phone:208-409-5393
Practice Address - Fax:208-944-0552
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-28
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDMID-103176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife