Provider Demographics
NPI:1467329771
Name:CAMPAIN, ANNIE ROSE
Entity type:Individual
Prefix:
First Name:ANNIE
Middle Name:ROSE
Last Name:CAMPAIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4344 17TH ST APT 3
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94114-1802
Mailing Address - Country:US
Mailing Address - Phone:970-685-0476
Mailing Address - Fax:
Practice Address - Street 1:4344 17TH ST APT 3
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94114-1802
Practice Address - Country:US
Practice Address - Phone:970-685-0476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-21
Last Update Date:2025-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86300830133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered