Provider Demographics
NPI:1609633619
Name:CAMPBELL, NAIVASHA DANIELLE
Entity Type:Individual
Prefix:
First Name:NAIVASHA
Middle Name:DANIELLE
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 1:15559 WYATT RD
Mailing Address - Street 2:
Mailing Address - City:EAST CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44112-4038
Mailing Address - Country:US
Mailing Address - Phone:440-902-1056
Mailing Address - Fax:
Practice Address - Street 1:26151 LAKE SHORE BLVD APT 920
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44132-1154
Practice Address - Country:US
Practice Address - Phone:440-902-1056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-05
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant