Provider Demographics
NPI:1346080165
Name:CAMPER, SI'MONE LEANNA (CPHT)
Entity type:Individual
Prefix:
First Name:SI'MONE
Middle Name:LEANNA
Last Name:CAMPER
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143 BLACK PRAIRIE ST
Mailing Address - Street 2:
Mailing Address - City:BOX ELDER
Mailing Address - State:MT
Mailing Address - Zip Code:59521-8759
Mailing Address - Country:US
Mailing Address - Phone:406-879-9314
Mailing Address - Fax:
Practice Address - Street 1:143 BLACK PRAIRIE ST
Practice Address - Street 2:
Practice Address - City:BOX ELDER
Practice Address - State:MT
Practice Address - Zip Code:59521-8759
Practice Address - Country:US
Practice Address - Phone:406-879-9314
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-29
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT30269412183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician