Provider Demographics
NPI:1083335038
Name:CAMPBELL, YVONNE ANNETTE
Entity Type:Individual
Prefix:
First Name:YVONNE
Middle Name:ANNETTE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7100 ELLENRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:OH
Mailing Address - Zip Code:45005-2533
Mailing Address - Country:US
Mailing Address - Phone:937-607-0430
Mailing Address - Fax:
Practice Address - Street 1:7100 ELLENRIDGE DR
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:OH
Practice Address - Zip Code:45005-2533
Practice Address - Country:US
Practice Address - Phone:937-607-0430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-08
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH05Medicaid