Provider Demographics
NPI:1285229070
Name:CAMPBELL, NICHOLAS N (NP-C)
Entity Type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:N
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1440 LARKMOOR BLVD
Mailing Address - Street 2:
Mailing Address - City:BERKLEY
Mailing Address - State:MI
Mailing Address - Zip Code:48072-1991
Mailing Address - Country:US
Mailing Address - Phone:248-224-5582
Mailing Address - Fax:
Practice Address - Street 1:1440 LARKMOOR BLVD
Practice Address - Street 2:
Practice Address - City:BERKLEY
Practice Address - State:MI
Practice Address - Zip Code:48072-1991
Practice Address - Country:US
Practice Address - Phone:248-224-5582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-04
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704322083363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty