Provider Demographics
NPI:1083242317
Name:SIM-CAMPOS, ISABEL (PA-C)
Entity Type:Individual
Prefix:
First Name:ISABEL
Middle Name:
Last Name:SIM-CAMPOS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 W 140TH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-4480
Mailing Address - Country:US
Mailing Address - Phone:952-808-3000
Mailing Address - Fax:952-456-7804
Practice Address - Street 1:1000 W 140TH ST STE 200
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-4480
Practice Address - Country:US
Practice Address - Phone:952-808-3000
Practice Address - Fax:952-808-7804
Is Sole Proprietor?:No
Enumeration Date:2020-03-31
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant