Provider Demographics
NPI:1528696911
Name:CAMPBELL, DAKOTA TROY (RN)
Entity type:Individual
Prefix:MR
First Name:DAKOTA
Middle Name:TROY
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16072 SPRINGDALE ST APT 115
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92649-1741
Mailing Address - Country:US
Mailing Address - Phone:317-601-2186
Mailing Address - Fax:
Practice Address - Street 1:1250 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813-3026
Practice Address - Country:US
Practice Address - Phone:562-437-0831
Practice Address - Fax:562-548-6604
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-31
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28199519A163WG0000X
CA95030276163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice