Provider Demographics
NPI:1578098927
Name:CAMPBELL, DENISE
Entity Type:Individual
Prefix:
First Name:DENISE
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 1:418 CROSSBOW DR
Mailing Address - Street 2:
Mailing Address - City:NEW STANTON
Mailing Address - State:PA
Mailing Address - Zip Code:15672-9485
Mailing Address - Country:US
Mailing Address - Phone:724-322-1043
Mailing Address - Fax:
Practice Address - Street 1:418 CROSSBOW DR
Practice Address - Street 2:
Practice Address - City:NEW STANTON
Practice Address - State:PA
Practice Address - Zip Code:15672-9485
Practice Address - Country:US
Practice Address - Phone:724-322-1043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-24
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No171M00000XOther Service ProvidersCase Manager/Care Coordinator