Provider Demographics
NPI:1679228332
Name:CAMPBELL, LISA ANN (FNP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 NEXUS DR STE NE3-100
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19803-3000
Mailing Address - Country:US
Mailing Address - Phone:302-777-0643
Mailing Address - Fax:302-623-7964
Practice Address - Street 1:4000 NEXUS DR STE NE3-100
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803-3000
Practice Address - Country:US
Practice Address - Phone:302-777-0643
Practice Address - Fax:302-623-7964
Is Sole Proprietor?:No
Enumeration Date:2022-02-21
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL1-0046662163W00000X
DELG-0011913363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse