Provider Demographics
NPI:1568593762
Name:CAMPANERO, NINA C
Entity Type:Individual
Prefix:
First Name:NINA
Middle Name:C
Last Name:CAMPANERO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NINA
Other - Middle Name:
Other - Last Name:CALDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5980 W 71ST ST STE 201
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46278-1785
Mailing Address - Country:US
Mailing Address - Phone:317-388-0800
Mailing Address - Fax:317-388-0805
Practice Address - Street 1:5980 W 71ST ST STE 201
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46278-1785
Practice Address - Country:US
Practice Address - Phone:317-388-0800
Practice Address - Fax:317-388-0805
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31004403A171W00000X
225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No171W00000XOther Service ProvidersContractor