Provider Demographics
NPI:1346984499
Name:CAMPBELL, DANA LYNN
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:LYNN
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:DANA
Other - Middle Name:LYNN
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:PO BOX 781076
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48278-1076
Mailing Address - Country:US
Mailing Address - Phone:317-528-4800
Mailing Address - Fax:317-865-8133
Practice Address - Street 1:1199 HADLEY RD STE 100
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46158-1788
Practice Address - Country:US
Practice Address - Phone:317-834-3263
Practice Address - Fax:317-834-5194
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-25
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71012608A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily