Provider Demographics
NPI:1568495927
Name:CAMPBELL, JUDITH MARY (MD)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:MARY
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 SHERWOOD AVE N
Mailing Address - Street 2:
Mailing Address - City:THIEF RIVER FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56701-2614
Mailing Address - Country:US
Mailing Address - Phone:218-681-0384
Mailing Address - Fax:
Practice Address - Street 1:109 S MINNESOTA ST
Practice Address - Street 2:NORTH VALLEY HEALTH CENTER
Practice Address - City:WARREN
Practice Address - State:MN
Practice Address - Zip Code:56762-1428
Practice Address - Country:US
Practice Address - Phone:218-745-4211
Practice Address - Fax:218-745-4215
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNMN207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDSTATE LICENCE NUMBEROther7874
MNSTATE LICENCE NUMBEROther40238