Healthcare Provider Details

I. General information

NPI: 1508425083
Provider Name (Legal Business Name): NAKIA MONIQUE CAMPBELL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NAKIA MONIQUE BROWN NP

II. Dates (important events)

Enumeration Date: 06/10/2019
Last Update Date: 06/05/2025
Certification Date: 06/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3348 W 87TH ST
CHICAGO IL
60652-3767
US

IV. Provider business mailing address

PO BOX 746715
ATLANTA GA
30374-6715
US

V. Phone/Fax

Practice location:
  • Phone: 773-776-4471
  • Fax: 773-564-3510
Mailing address:
  • Phone: 773-352-1515
  • Fax: 312-929-0373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.018839
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: