Provider Demographics
NPI:1225716582
Name:CAMPOS-SMITH, MARISELLA (LPN)
Entity Type:Individual
Prefix:
First Name:MARISELLA
Middle Name:
Last Name:CAMPOS-SMITH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:MARISELLA
Other - Middle Name:
Other - Last Name:CAMPOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:235 W LANCASTER AVE
Mailing Address - Street 2:
Mailing Address - City:DEVON
Mailing Address - State:PA
Mailing Address - Zip Code:19333-1560
Mailing Address - Country:US
Mailing Address - Phone:484-654-9977
Mailing Address - Fax:484-325-6219
Practice Address - Street 1:235 W LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:DEVON
Practice Address - State:PA
Practice Address - Zip Code:19333-1560
Practice Address - Country:US
Practice Address - Phone:484-654-9977
Practice Address - Fax:484-325-6219
Is Sole Proprietor?:No
Enumeration Date:2023-07-07
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN292425164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse