Provider Demographics
NPI:1538874417
Name:CAMPBELL, IRINA M
Entity type:Individual
Prefix:
First Name:IRINA
Middle Name:M
Last Name:CAMPBELL
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 1:875 E 230 N
Mailing Address - Street 2:
Mailing Address - City:SANTAQUIN
Mailing Address - State:UT
Mailing Address - Zip Code:84655-5720
Mailing Address - Country:US
Mailing Address - Phone:801-592-4451
Mailing Address - Fax:
Practice Address - Street 1:875 E 230 N
Practice Address - Street 2:
Practice Address - City:SANTAQUIN
Practice Address - State:UT
Practice Address - Zip Code:84655-5720
Practice Address - Country:US
Practice Address - Phone:801-592-4451
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-16
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT00000000363LF0000X
UT10835145-3102163WP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily