Healthcare Provider Details

I. General information

NPI: 1932194875
Provider Name (Legal Business Name): FRED CAMPBELL LEGE ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2005
Last Update Date: 11/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 E VERMIJO AVE STE 16
COLORADO SPRINGS CO
80903-2208
US

IV. Provider business mailing address

27 E VERMIJO AVE STE 16
COLORADO SPRINGS CO
80903-2208
US

V. Phone/Fax

Practice location:
  • Phone: 710-520-7080
  • Fax:
Mailing address:
  • Phone: 710-520-7080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN 181292/5312
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: