Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 28164598A | IN |
NPI | 1053687988 |
---|---|
Provider Name | Candice S Campbell |
First Address | Indianapolis, IN 46250-2805 |
Second Address | Indianapolis, IN 46256-1695 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2012 |
Last Update Date | 14/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
201059440 | (05) | IN |
CAM104363128 | NCC (01) | IN |
P01512395 | MEDICARE RR (01) | IN |