Healthcare Provider Details

I. General information

NPI: 1164700548
Provider Name (Legal Business Name): HEIDI CAMPBELL CD(DONA), MBA, CMR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2011
Last Update Date: 10/21/2020
Certification Date: 10/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3343 EASTWOOD DR
CHARLOTTE NC
28205-2111
US

IV. Provider business mailing address

3343 EASTWOOD DR
CHARLOTTE NC
28205-2111
US

V. Phone/Fax

Practice location:
  • Phone: 704-226-5443
  • Fax:
Mailing address:
  • Phone: 704-226-5443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number6938
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: