Provider Demographics
NPI:1477192367
Name:CAMPBELL, DIANE
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
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 1:84 GREEN DR
Mailing Address - Street 2:
Mailing Address - City:RICE
Mailing Address - State:VA
Mailing Address - Zip Code:23966-2661
Mailing Address - Country:US
Mailing Address - Phone:434-808-2673
Mailing Address - Fax:
Practice Address - Street 1:2278 PRINCE EDWARD HIGHWAY
Practice Address - Street 2:
Practice Address - City:RICE
Practice Address - State:VA
Practice Address - Zip Code:23966
Practice Address - Country:US
Practice Address - Phone:434-767-5207
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-26
Last Update Date:2019-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider