Provider Demographics
NPI:1003887951
Name:CAMPBELL, THELMA (NURSE)
Entity Type:Individual
Prefix:MS
First Name:THELMA
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 MEDFORD LN
Mailing Address - Street 2:
Mailing Address - City:WILLINGBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08046-3121
Mailing Address - Country:US
Mailing Address - Phone:609-835-0155
Mailing Address - Fax:
Practice Address - Street 1:5250 NEW JERSEY AVE
Practice Address - Street 2:
Practice Address - City:FORT DIX
Practice Address - State:NJ
Practice Address - Zip Code:08640-5017
Practice Address - Country:US
Practice Address - Phone:609-562-6114
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNO 128163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse