Provider Demographics
NPI:1386232585
Name:CAMPAIGN, KIMBERLY (LPN)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:CAMPAIGN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3254 ROUTE 39
Mailing Address - Street 2:
Mailing Address - City:FORESTVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14062-9631
Mailing Address - Country:US
Mailing Address - Phone:716-410-2289
Mailing Address - Fax:
Practice Address - Street 1:3254 ROUTE 39
Practice Address - Street 2:
Practice Address - City:FORESTVILLE
Practice Address - State:NY
Practice Address - Zip Code:14062-9631
Practice Address - Country:US
Practice Address - Phone:716-410-2289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-04
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY256621-01164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse