Provider Demographics
NPI:1275857229
Name:CAMPBELL, BETTY LUCILLE (RN)
Entity Type:Individual
Prefix:MS
First Name:BETTY
Middle Name:LUCILLE
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 1:5622 SR 303
Mailing Address - Street 2:PO BOX 307
Mailing Address - City:WAKEMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44889
Mailing Address - Country:US
Mailing Address - Phone:440-839-2684
Mailing Address - Fax:
Practice Address - Street 1:5622 SR 303
Practice Address - Street 2:
Practice Address - City:WAKEMAN
Practice Address - State:OH
Practice Address - Zip Code:44889-9451
Practice Address - Country:US
Practice Address - Phone:440-839-2684
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-19
Last Update Date:2010-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.097569163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse