Provider Demographics
NPI:1578863130
Name:CAMPBELL, TREVA A (RN)
Entity Type:Individual
Prefix:
First Name:TREVA
Middle Name:A
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 1:15 HANNA PL
Mailing Address - Street 2:#3
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14620-2218
Mailing Address - Country:US
Mailing Address - Phone:585-241-9276
Mailing Address - Fax:
Practice Address - Street 1:15 HANNA PL
Practice Address - Street 2:#3
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620-2218
Practice Address - Country:US
Practice Address - Phone:585-241-9276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-29
Last Update Date:2010-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY526193163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse