Provider Demographics
NPI:1386120202
Name:CAMP, MARIA SHOAF MACDONALD (CPM, LLM)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:SHOAF MACDONALD
Last Name:CAMP
Suffix:
Gender:F
Credentials:CPM, LLM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2103 E LEE ST
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72701-7335
Mailing Address - Country:US
Mailing Address - Phone:913-738-9766
Mailing Address - Fax:
Practice Address - Street 1:2103 E LEE ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72701-7335
Practice Address - Country:US
Practice Address - Phone:913-738-9766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-13
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374J00000X
AR032019176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No374J00000XNursing Service Related ProvidersDoula