Provider Demographics
NPI:1235587254
Name:CAMPBELL, REGINA (RN)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38340 TAMARAC BLVD APT 219
Mailing Address - Street 2:
Mailing Address - City:WILLOUGHBY
Mailing Address - State:OH
Mailing Address - Zip Code:44094-8135
Mailing Address - Country:US
Mailing Address - Phone:440-454-1953
Mailing Address - Fax:
Practice Address - Street 1:38340 TAMARAC BLVD APT 219
Practice Address - Street 2:
Practice Address - City:WILLOUGHBY
Practice Address - State:OH
Practice Address - Zip Code:44094-8135
Practice Address - Country:US
Practice Address - Phone:440-454-1953
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-31
Last Update Date:2023-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH502988163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse