Provider Demographics
NPI:1518513191
Name:CAMPOS, MALINA (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:MALINA
Middle Name:
Last Name:CAMPOS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 LONGVIEW DR
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60124-1219
Mailing Address - Country:US
Mailing Address - Phone:630-802-9339
Mailing Address - Fax:
Practice Address - Street 1:919 N PLUM GROVE RD STE A
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-4760
Practice Address - Country:US
Practice Address - Phone:847-469-4612
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-10
Last Update Date:2019-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.019599363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner