Healthcare Provider Details

I. General information

NPI: 1447273255
Provider Name (Legal Business Name): CATHIE N CAMPBELL DNP,PMHNP-BC,GNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 12/03/2021
Certification Date: 12/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1521B 24TH AVE S STE 203
GRAND FORKS ND
58201-6775
US

IV. Provider business mailing address

1521B 24TH AVE S STE 203
GRAND FORKS ND
58201-6775
US

V. Phone/Fax

Practice location:
  • Phone: 701-885-7920
  • Fax: 701-757-0859
Mailing address:
  • Phone: 701-885-7920
  • Fax: 701-757-0859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR50899
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number539050
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAP111274
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberR50899
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: