Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | CH8164 | FL |
Y | 111NN1001X | Nutrition | 4356-012 | WI |
NPI | 1538177597 |
---|---|
Provider Name | Dr. Sage Lisa Marie Campione |
First Address | St. Simons Island, GA 31522-4254 |
Second Address | St. Simons Island, GA 31522-4254 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2006 |
Last Update Date | 25/01/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U85417 | (02) |