Provider Demographics
NPI:1154860062
Name:CAMPOS, LYSETTE BAUI (RN)
Entity Type:Individual
Prefix:
First Name:LYSETTE
Middle Name:BAUI
Last Name:CAMPOS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:LYSETTE
Other - Middle Name:ZIPAGAN
Other - Last Name:BAUI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2218 RETTA DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78418-5409
Mailing Address - Country:US
Mailing Address - Phone:808-772-1378
Mailing Address - Fax:
Practice Address - Street 1:MADIGAN ARMY MEDICAL CTR
Practice Address - Street 2:9040 JACKSON AVE, ATTN: MCHJ-CLQ-C
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98431-1100
Practice Address - Country:US
Practice Address - Phone:253-968-1110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-13
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIRN-73516163W00000X
TX849674163W00000X
WARN60411654163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse