Healthcare Provider Details

I. General information

NPI: 1528696911
Provider Name (Legal Business Name): DAKOTA TROY CAMPBELL RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2020
Last Update Date: 03/31/2020
Certification Date: 03/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 PACIFIC AVE
LONG BEACH CA
90813-3026
US

IV. Provider business mailing address

16072 SPRINGDALE ST APT 115
HUNTINGTON BEACH CA
92649-1741
US

V. Phone/Fax

Practice location:
  • Phone: 562-437-0831
  • Fax: 562-548-6604
Mailing address:
  • Phone: 317-601-2186
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number28199519A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number95030276
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: