Provider Demographics
NPI:1295028470
Name:CAMPBELL, ROSE MARIE (PNP-C)
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:MARIE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:PNP-C
Other - Prefix:
Other - First Name:ROSE
Other - Middle Name:MARIE
Other - Last Name:CSONKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 1367
Mailing Address - Street 2:
Mailing Address - City:SULPHUR SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:75483-1367
Mailing Address - Country:US
Mailing Address - Phone:903-885-5439
Mailing Address - Fax:
Practice Address - Street 1:105 MEDICAL PLZ
Practice Address - Street 2:
Practice Address - City:SULPHUR SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:75482-2136
Practice Address - Country:US
Practice Address - Phone:903-885-5439
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-22
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP132989363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics