Healthcare Provider Details

I. General information

NPI: 1609872399
Provider Name (Legal Business Name): DR. NATHALIE A CAMPBELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 11/18/2021
Certification Date: 11/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 EDMOND DR
WARWICK RI
02886-8520
US

IV. Provider business mailing address

28 EDMOND DR
WARWICK RI
02886-8520
US

V. Phone/Fax

Practice location:
  • Phone: 401-474-3978
  • Fax:
Mailing address:
  • Phone: 401-474-3978
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberMD10234
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: