Healthcare Provider Details

I. General information

NPI: 1851570048
Provider Name (Legal Business Name): MRS. KAREN MARIE CAMPBELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAREN MARIE GREEN

II. Dates (important events)

Enumeration Date: 10/24/2007
Last Update Date: 10/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 SAN PEDRO DR SE
ALBUQUERQUE NM
87108-5153
US

IV. Provider business mailing address

7204 SPRUCE MOUNTAIN LOOP NE
RIO RANCHO NM
87144-6797
US

V. Phone/Fax

Practice location:
  • Phone: 505-265-1711
  • Fax:
Mailing address:
  • Phone: 505-795-4015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberX-05988
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: