MEDICARE: LAUREN CAMPOS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1073279543
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN CAMPOS

Provider Business Mailing Address
First Line	:	10192 S MARYLAND PKWY APT 2068
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89183-7346
Country	:	US
Telephone Number	:	702-824-1563
Fax Number	:

Provider Business Practice Location Address
First Line	:	4625 WHITE STORK DR
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89084-2640
Country	:	US
Telephone Number	:	702-824-1563
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/09/2021
Last Update Date	:	11/09/2021

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Directions to “ LAUREN CAMPOS ” Practice Location

Language	Start Address	Practice Location

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