MEDICARE: STEFANIE DE CAMPO

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	171400000X	Health & Wellness Coach

General Provider Information

NPI Number	:	1205605243
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEFANIE DE CAMPO

Provider Business Mailing Address
First Line	:	16250 E TERRACE LN
Second Line	:
City	:	FOUNTAIN HILLS
State	:	AZ
Zip	:	85268-6693
Country	:	US
Telephone Number	:	480-853-7178
Fax Number	:

Provider Business Practice Location Address
First Line	:	4545 N 36TH ST STE 216
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85018-3474
Country	:	US
Telephone Number	:	480-853-7178
Fax Number	:

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

Provider Enumeration Date	:	01/01/2024
Last Update Date	:	01/02/2024

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Directions to “ STEFANIE DE CAMPO ” Practice Location

Language	Start Address	Practice Location

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