Provider Demographics
NPI:1669630448
Name:CAMPBELL, LAINE H (ARNP)
Entity Type:Individual
Prefix:
First Name:LAINE
Middle Name:H
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9033
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34995-9033
Mailing Address - Country:US
Mailing Address - Phone:772-223-5945
Mailing Address - Fax:772-288-5871
Practice Address - Street 1:300 SE HOSPITAL AVE
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-2338
Practice Address - Country:US
Practice Address - Phone:772-223-5945
Practice Address - Fax:772-223-5871
Is Sole Proprietor?:No
Enumeration Date:2008-05-28
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND 5140133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLND5140OtherFL LICENSE