Basic Information
| Provider Information | |||||||||
| NPI: | 1710613930 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SCHOOLCRAFT CAMPOS | ||||||||
| FirstName: | KRISTEN | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5717 PATRICK ST SW | ||||||||
| Address2: | |||||||||
| City: | CANTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 447063246 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8083913009 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 919 2ND ST NE | ||||||||
| Address2: | |||||||||
| City: | CANTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 447041132 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3304547917 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/29/2022 | ||||||||
| LastUpdateDate: | 07/29/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/29/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WC0400X | RN.457457 | OH | Y | Nursing Service Providers | Registered Nurse | Case Management |
No ID Information.