Provider Demographics
NPI:1467964957
Name:CAMPBELL, BEVERLEY HYACINTH (LPN)
Entity Type:Individual
Prefix:MS
First Name:BEVERLEY
Middle Name:HYACINTH
Last Name:CAMPBELL
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:PO BOX 353
Mailing Address - Street 2:
Mailing Address - City:REDDING RIDGE
Mailing Address - State:CT
Mailing Address - Zip Code:06876
Mailing Address - Country:US
Mailing Address - Phone:203-556-5319
Mailing Address - Fax:
Practice Address - Street 1:108 BLACKROCK TURNPIKE
Practice Address - Street 2:
Practice Address - City:REDDING RIDGE
Practice Address - State:CT
Practice Address - Zip Code:06896
Practice Address - Country:US
Practice Address - Phone:203-556-5319
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-25
Last Update Date:2017-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT028092164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse