Provider Demographics
NPI:1174949671
Name:CANDICE S CAMPBELL
Entity type:Organization
Organization Name:CANDICE S CAMPBELL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BIRTH DOULA
Authorized Official - Prefix:
Authorized Official - First Name:CANDICE
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:260-413-5696
Mailing Address - Street 1:7605 REGINA DR
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46815-8248
Mailing Address - Country:US
Mailing Address - Phone:260-413-5696
Mailing Address - Fax:
Practice Address - Street 1:7605 REGINA DR
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46815-8248
Practice Address - Country:US
Practice Address - Phone:260-413-5696
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-09
Last Update Date:2014-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN374J00000XOtherPRIVATE INSURANCE