MEDICARE: MRS. MILTIA ALEXA MARIE CAMPBELL III

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	374U00000X	Home Health Aide	6701877	OH
2	225400000X	Rehabilitation Practitioner

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1679699458
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MILTIA ALEXA MARIE CAMPBELL III

Provider Business Mailing Address
First Line	:	1505 JOHN BEVY CT
Second Line	:
City	:	N LAS VEGAS
State	:	NV
Zip	:	89086-1382
Country	:	US
Telephone Number	:	330-389-1250
Fax Number	:

Provider Business Practice Location Address
First Line	:	1505 JOHN BEVY CT
Second Line	:
City	:	N LAS VEGAS
State	:	NV
Zip	:	89086-1382
Country	:	US
Telephone Number	:	330-389-1250
Fax Number	:

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

Provider Enumeration Date	:	03/22/2007
Last Update Date	:	09/02/2015

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