Healthcare Provider Details

I. General information

NPI: 1811239874
Provider Name (Legal Business Name): KATREVIA SHYTERIA CAMPBELL CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2013
Last Update Date: 03/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16601 NE 19TH AVE
NORTH MIAMI BEACH FL
33162-3149
US

IV. Provider business mailing address

351 NW 201ST ST
MIAMI FL
33169-2930
US

V. Phone/Fax

Practice location:
  • Phone: 305-944-2902
  • Fax:
Mailing address:
  • Phone: 305-409-7476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberARNP9270010
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: