Provider Demographics
NPI:1720591563
Name:CAMPBELL, NAOMI JEAN
Entity Type:Individual
Prefix:
First Name:NAOMI
Middle Name:JEAN
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8217 W 30 1/2 ST APT 1
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55426-3503
Mailing Address - Country:US
Mailing Address - Phone:612-964-0846
Mailing Address - Fax:
Practice Address - Street 1:8217 W 30 1/2 ST APT 1
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55426-3503
Practice Address - Country:US
Practice Address - Phone:612-964-0846
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-15
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty