Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 1147 | AK |
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 200950092NP | OR |
NPI | 1003071499 |
---|---|
Provider Name | Mr. Nicholas J Campo III |
First Address | Bend, OR 97702-2988 |
Second Address | Bend, OR 97702-2988 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2008 |
Last Update Date | 15/07/2016 |