Provider Demographics
NPI:1235446444
Name:CAMPBELL, AMY LEIGH (RD, LDN)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:LEIGH
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:MISS
Other - First Name:AMY
Other - Middle Name:LEIGH
Other - Last Name:HUMENIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:1301 CARLISLE ST
Mailing Address - Street 2:
Mailing Address - City:NATRONA HEIGHTS
Mailing Address - State:PA
Mailing Address - Zip Code:15065-1152
Mailing Address - Country:US
Mailing Address - Phone:724-226-7419
Mailing Address - Fax:724-226-7216
Practice Address - Street 1:1301 CARLISLE ST
Practice Address - Street 2:
Practice Address - City:NATRONA HEIGHTS
Practice Address - State:PA
Practice Address - Zip Code:15065-1152
Practice Address - Country:US
Practice Address - Phone:724-226-7419
Practice Address - Fax:724-226-7216
Is Sole Proprietor?:No
Enumeration Date:2010-09-09
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN001441133N00000X
PA714471133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007447680001Medicaid
PA390032Medicare Oscar/Certification