Healthcare Provider Details

I. General information

NPI: 1497179014
Provider Name (Legal Business Name): VICTORIA LYNNE CAMPBELL NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2014
Last Update Date: 02/05/2020
Certification Date: 02/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 E CHURCH ST
MARSHALLTOWN IA
50158-2947
US

IV. Provider business mailing address

1200 UNIVERSITY AVE STE 200
DES MOINES IA
50314-2355
US

V. Phone/Fax

Practice location:
  • Phone: 641-753-4021
  • Fax: 641-753-4025
Mailing address:
  • Phone: 515-248-1447
  • Fax: 515-248-1440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA099266
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: