Provider Demographics
NPI:1073117529
Name:CAMPBELL, DAWNETTE GAYLENE (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:DAWNETTE
Middle Name:GAYLENE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10542 BLACK PINE LN
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20603-6701
Mailing Address - Country:US
Mailing Address - Phone:301-537-3642
Mailing Address - Fax:240-669-9997
Practice Address - Street 1:10542 BLACK PINE LN
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20603-6701
Practice Address - Country:US
Practice Address - Phone:301-537-3642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-25
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR219301363LP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health