Provider Demographics
NPI:1417947607
Name:CAMPBELL, LISA M (RN)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 BELMONTE
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92620-2701
Mailing Address - Country:US
Mailing Address - Phone:949-552-0598
Mailing Address - Fax:949-387-2185
Practice Address - Street 1:14 BELMONTE
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92620-2701
Practice Address - Country:US
Practice Address - Phone:949-552-0598
Practice Address - Fax:949-387-2185
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA519228163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice