Provider Demographics
NPI:1295356244
Name:CAMPBELL, LAVESHIA M
Entity Type:Individual
Prefix:
First Name:LAVESHIA
Middle Name:M
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 ONEIL ST
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-3518
Mailing Address - Country:US
Mailing Address - Phone:845-532-4949
Mailing Address - Fax:
Practice Address - Street 1:143 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-5048
Practice Address - Country:US
Practice Address - Phone:845-532-4949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-30
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY935263798OtherID CARD