Provider Demographics
NPI:1720368855
Name:CAMPBELL, MADELENA (RN, CPNP-BC, CPN)
Entity Type:Individual
Prefix:
First Name:MADELENA
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:RN, CPNP-BC, CPN
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:PO BOX 1810
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39502-1810
Mailing Address - Country:US
Mailing Address - Phone:228-896-6441
Mailing Address - Fax:228-896-6576
Practice Address - Street 1:12261 HIGHWAY 49
Practice Address - Street 2:SUITE 11
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-2975
Practice Address - Country:US
Practice Address - Phone:228-867-5185
Practice Address - Fax:228-867-5189
Is Sole Proprietor?:No
Enumeration Date:2011-08-20
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MSR868611163W00000X, 363LP0200X
MS868611363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse