Healthcare Provider Details

I. General information

NPI: 1386120202
Provider Name (Legal Business Name): MARIA SHOAF MACDONALD CAMP CPM, LLM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2018
Last Update Date: 11/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2103 E LEE ST
FAYETTEVILLE AR
72701-7335
US

IV. Provider business mailing address

2103 E LEE ST
FAYETTEVILLE AR
72701-7335
US

V. Phone/Fax

Practice location:
  • Phone: 913-738-9766
  • Fax:
Mailing address:
  • Phone: 913-738-9766
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number032019
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: