Provider Demographics
NPI:1801663604
Name:CAMPANOZZI, NANCY ANN (MT)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:ANN
Last Name:CAMPANOZZI
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5001 BLUE STONE RD NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-2023
Mailing Address - Country:US
Mailing Address - Phone:505-681-4361
Mailing Address - Fax:
Practice Address - Street 1:3321 CANDELARIA RD NE STE 122
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-1968
Practice Address - Country:US
Practice Address - Phone:505-681-4361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-11
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMT-2023-0282225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist