Healthcare Provider Details

I. General information

NPI: 1568495927
Provider Name (Legal Business Name): JUDITH MARY CAMPBELL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 S MINNESOTA ST NORTH VALLEY HEALTH CENTER
WARREN MN
56762-1428
US

IV. Provider business mailing address

201 SHERWOOD AVE N
THIEF RIVER FALLS MN
56701-2614
US

V. Phone/Fax

Practice location:
  • Phone: 218-745-4211
  • Fax: 218-745-4215
Mailing address:
  • Phone: 218-681-0384
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMN
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: