Provider Demographics
NPI:1407615412
Name:CAMPAGNA, KATE ELIZABETH (BS)
Entity Type:Individual
Prefix:
First Name:KATE
Middle Name:ELIZABETH
Last Name:CAMPAGNA
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 TWELVEOAK HILL DR
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-1728
Mailing Address - Country:US
Mailing Address - Phone:415-328-3094
Mailing Address - Fax:
Practice Address - Street 1:42 TWELVEOAK HILL DR
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-1728
Practice Address - Country:US
Practice Address - Phone:415-328-3094
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-14
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program