Provider Demographics
NPI:1750628087
Name:CAMPBELL, RAYMOND M SR
Entity Type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:M
Last Name:CAMPBELL
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:667 S FIRESTONE BLVD
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44301-3123
Mailing Address - Country:US
Mailing Address - Phone:330-962-6764
Mailing Address - Fax:
Practice Address - Street 1:667 S FIRESTONE BLVD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44301-3123
Practice Address - Country:US
Practice Address - Phone:330-962-6764
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-07
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 103541164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse