Provider Demographics
NPI:1598452971
Name:CAMPBELL, AMANDA RENEE (APRN-CNP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:RENEE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2272 GRASMERE AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43211-2010
Mailing Address - Country:US
Mailing Address - Phone:567-208-8623
Mailing Address - Fax:
Practice Address - Street 1:920 N HAMILTON RD
Practice Address - Street 2:
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-1757
Practice Address - Country:US
Practice Address - Phone:614-293-5123
Practice Address - Fax:614-293-4980
Is Sole Proprietor?:No
Enumeration Date:2023-04-18
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.453853163WG0000X
OHAPRN.CNP.0034372363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice