NPIMap

Organization Active NPI

Abundant Life Enterprises, LLC

  • Obstetrics & Gynecology Physician
  • Tucson, AZ
National Provider Identifier
1104153097
Registry record updated Mar 16, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
Legal business name
ABUNDANT LIFE ENTERPRISES, LLC
Practice address
3055 W Ina Rd
Suite 195
Tucson, AZ 85741-2107
Phone
(520) 293-1117
Fax
(520) 293-7701
NPI assigned
Nov 12, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 16, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Sharon R. Campbell, WHNP-C
Title
Owner
Phone
(520) 293-1117

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207V00000X Primary

Addresses

Primary practice location

3055 W Ina Rd
Suite 195
Tucson, AZ 85741-2107

Mailing address

3055 W. Ina Rd.
#195
Tucson, AZ 85741-2136
Phone (520) 293-1117

Other identifiers 4

IdentifierTypeStateIssuer
Z79110OtherAZMEDICARE - (A.L.E. - SC IND )
429971MedicaidAZ
Z79108OtherAZMEDICARE GRP (A.L.E) -
192914MedicaidAZ

Other names 1

  • A New Creation Women's Clinic Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1257984000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1458086400000",
    "number": "1104153097",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3055 W. INA RD.",
            "address_2": "#195",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857412136",
            "telephone_number": "520-293-1117",
            "fax_number": "520-293-7701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3055 W INA RD",
            "address_2": "SUITE 195",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857412107",
            "telephone_number": "520-293-1117",
            "fax_number": "520-293-7701"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ABUNDANT LIFE ENTERPRISES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-11-12",
        "last_updated": "2016-03-16",
        "status": "A",
        "authorized_official_last_name": "CAMPBELL",
        "authorized_official_first_name": "SHARON",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "520-293-1117",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "WHNP-C"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE - (A.L.E. - SC IND )",
            "identifier": "Z79110",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "429971",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GRP (A.L.E) -",
            "identifier": "Z79108",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "192914",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "A New Creation Women's Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tucson, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.