Provider Demographics
NPI:1679356679
Name:CAMPBELL, MONISHA JANAE
Entity Type:Individual
Prefix:
First Name:MONISHA
Middle Name:JANAE
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 1:1905 ROOT AVE NE
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44705-2241
Mailing Address - Country:US
Mailing Address - Phone:330-949-1761
Mailing Address - Fax:
Practice Address - Street 1:1905 ROOT AVE NE
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44705-2241
Practice Address - Country:US
Practice Address - Phone:330-949-1761
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-15
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide