Provider Demographics
NPI:1912741034
Name:HAMPTON, MINDI KAE (RN BSN)
Entity type:Individual
Prefix:
First Name:MINDI
Middle Name:KAE
Last Name:HAMPTON
Suffix:
Gender:F
Credentials:RN BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:821 PASEO TOSAMAR
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93012-8177
Mailing Address - Country:US
Mailing Address - Phone:818-456-7304
Mailing Address - Fax:
Practice Address - Street 1:821 PASEO TOSAMAR
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93012-8177
Practice Address - Country:US
Practice Address - Phone:818-456-7304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-24
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA516918163WI0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy