Provider Demographics
NPI:1679124176
Name:CAMPBELL, CHLOE ALEXANDRIA (CM)
Entity Type:Individual
Prefix:MS
First Name:CHLOE
Middle Name:ALEXANDRIA
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:CM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 MINNA ST FL 1
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-2117
Mailing Address - Country:US
Mailing Address - Phone:718-473-4189
Mailing Address - Fax:
Practice Address - Street 1:2183 OCEAN AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-2303
Practice Address - Country:US
Practice Address - Phone:718-336-4119
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-25
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001944367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife