Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175L00000X | Homeopath |
NPI | 1063763563 |
---|---|
Provider Name | Lacey Campbell |
First Address | Bismarck, ND 58503-0973 |
Second Address | Bismarck, ND 58503-0973 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/09/2012 |
Last Update Date | 24/09/2012 |