1568593762 NPI number — NINA C CAMPANERO

Table of content: NINA C CAMPANERO (NPI 1568593762)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568593762 NPI number — NINA C CAMPANERO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CAMPANERO
Provider First Name:
NINA
Provider Middle Name:
C
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CALDA
Provider Other First Name:
NINA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1568593762
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/12/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5980 W 71ST ST STE 201
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46278-1785
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-388-0800
Provider Business Mailing Address Fax Number:
317-388-0805

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5980 W 71ST ST STE 201
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INDIANAPOLIS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46278-1785
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-388-0800
Provider Business Practice Location Address Fax Number:
317-388-0805
Provider Enumeration Date:
03/08/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171W00000X , with the licence number:  31004403A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)