Provider Demographics
NPI:1508205923
Name:CAMPBELL, COURTNEY (CNA)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 SMILEY AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45240-1826
Mailing Address - Country:US
Mailing Address - Phone:513-550-3260
Mailing Address - Fax:
Practice Address - Street 1:920 SMILEY AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45240
Practice Address - Country:US
Practice Address - Phone:513-550-3260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-19
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH501019130905376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide