Healthcare Provider Details

I. General information

NPI: 1548583040
Provider Name (Legal Business Name): ANGELA ELIZABETH CAMPBELL FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2010
Last Update Date: 06/06/2023
Certification Date: 06/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 CALLE DEL PRESIDENTE
BERNALILLO NM
87004-6091
US

IV. Provider business mailing address

PO BOX 5730
BERNALILLO NM
87004-5730
US

V. Phone/Fax

Practice location:
  • Phone: 505-867-2324
  • Fax:
Mailing address:
  • Phone: 505-867-2324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP-01617
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: