Healthcare Provider Details

I. General information

NPI: 1366375545
Provider Name (Legal Business Name): LAUREN CAMPBELL
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 HARVARD ST SE
MINNEAPOLIS MN
55455-0353
US

IV. Provider business mailing address

938 WESCOTT TRL APT 104
EAGAN MN
55123-2283
US

V. Phone/Fax

Practice location:
  • Phone: 612-624-5959
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: