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NPI Code Detail

MEDICARE: MS. WILLA R. CAMPBELL MSN, CNM, APRN

MEDICARE: MS. WILLA R. CAMPBELL MSN, CNM, APRN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1367A00000XAdvanced Practice MidwifeCNM465MN

General Provider Information

NPI Number : 1174931216
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. WILLA R. CAMPBELL MSN, CNM, APRN
Provider Business Mailing Address
First Line : 2606 CHICAGO AVE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55407-3706
Country : US
Telephone Number : 612-545-5311
Fax Number : 612-224-9622
Provider Business Practice Location Address
First Line : 2606 CHICAGO AVE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55407-3706
Country : US
Telephone Number : 612-545-5311
Fax Number : 612-224-9622
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/31/2014
Last Update Date : 10/29/2021

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