Provider Demographics
NPI:1033174925
Name:CAMPBELL, ALISON MARY
Entity Type:Individual
Prefix:MRS
First Name:ALISON
Middle Name:MARY
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALISON
Other - Middle Name:MARY
Other - Last Name:ROTHBAUER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11-3 PARKSIDE CIRCLE
Mailing Address - Street 2:
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-1686
Mailing Address - Country:US
Mailing Address - Phone:330-533-7690
Mailing Address - Fax:
Practice Address - Street 1:11-3 PARKSIDE CIRCLE
Practice Address - Street 2:
Practice Address - City:CANFIELD
Practice Address - State:OH
Practice Address - Zip Code:44406-1686
Practice Address - Country:US
Practice Address - Phone:330-533-7690
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2080377Medicaid