Healthcare Provider Details

I. General information

NPI: 1235130428
Provider Name (Legal Business Name): PATRICIA L CAMPBELL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 01/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 PARK AVE
MINNEAPOLIS MN
55415-1623
US

IV. Provider business mailing address

929 PORTLAND AVE APT 2102
MINNEAPOLIS MN
55404-1271
US

V. Phone/Fax

Practice location:
  • Phone: 612-873-0000
  • Fax:
Mailing address:
  • Phone: 260-437-7187
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number10000455A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number11267
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: