Provider Demographics
NPI:1275768012
Name:CAMPBELL, DORIS RUTH (FNP, MSN)
Entity Type:Individual
Prefix:MS
First Name:DORIS
Middle Name:RUTH
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:FNP, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 4TH ST APT 14
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94710-1328
Mailing Address - Country:US
Mailing Address - Phone:510-708-3390
Mailing Address - Fax:
Practice Address - Street 1:2740 GRANT ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-2265
Practice Address - Country:US
Practice Address - Phone:925-674-2932
Practice Address - Fax:925-674-2118
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-22
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17954363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily