Provider Demographics
NPI:1174931216
Name:CAMPBELL, WILLA R (MSN, CNM, APRN)
Entity type:Individual
Prefix:MS
First Name:WILLA
Middle Name:R
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:MSN, CNM, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2606 CHICAGO AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-3706
Mailing Address - Country:US
Mailing Address - Phone:612-545-5311
Mailing Address - Fax:612-224-9622
Practice Address - Street 1:2606 CHICAGO AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-3706
Practice Address - Country:US
Practice Address - Phone:612-545-5311
Practice Address - Fax:612-224-9622
Is Sole Proprietor?:No
Enumeration Date:2014-07-31
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCNM465367A00000X
RIAPRN02242363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife