Healthcare Provider Details

I. General information

NPI: 1174949671
Provider Name (Legal Business Name): CANDICE S CAMPBELL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2014
Last Update Date: 03/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7605 REGINA DR
FORT WAYNE IN
46815-8248
US

IV. Provider business mailing address

7605 REGINA DR
FORT WAYNE IN
46815-8248
US

V. Phone/Fax

Practice location:
  • Phone: 260-413-5696
  • Fax:
Mailing address:
  • Phone: 260-413-5696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name: CANDICE CAMPBELL
Title or Position: BIRTH DOULA
Credential:
Phone: 260-413-5696