Provider Demographics
NPI:1164788238
Name:CAMPBELL, RONALD (RN)
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:178 EVERGREEN AVE
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11717-4120
Mailing Address - Country:US
Mailing Address - Phone:631-398-1131
Mailing Address - Fax:
Practice Address - Street 1:178 EVERGREEN AVE
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:NY
Practice Address - Zip Code:11717-4120
Practice Address - Country:US
Practice Address - Phone:631-398-1131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-03
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY459804-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse