MEDICARE: MS. CINNAMON DALE CAMPBELL FNP

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	363LF0000X	Family Nurse Practitioner	2014010117	MO

General Provider Information

NPI Number	:	1083019020
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CINNAMON DALE CAMPBELL FNP

Provider Business Mailing Address
First Line	:	PO BOX 7412011
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60674-2011
Country	:	US
Telephone Number	:	314-362-9123
Fax Number	:	314-747-9160

Provider Business Practice Location Address
First Line	:	11133 DUNN RD
Second Line	:	DEPT EMERGENCY MED
City	:	SAINT LOUIS
State	:	MO
Zip	:	63136-6163
Country	:	US
Telephone Number	:	314-362-9123
Fax Number	:	314-747-9160

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

Provider Enumeration Date	:	11/04/2014
Last Update Date	:	12/08/2025

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