Provider Demographics
NPI:1760458434
Name:CAMPBELL, SHIRLEY MAUREEN (NP)
Entity Type:Individual
Prefix:MRS
First Name:SHIRLEY
Middle Name:MAUREEN
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1008 S SPRING AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-2520
Mailing Address - Country:US
Mailing Address - Phone:314-977-2140
Mailing Address - Fax:314-977-1660
Practice Address - Street 1:1225 S GRAND BLVD # 3B
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63104-1016
Practice Address - Country:US
Practice Address - Phone:314-257-3760
Practice Address - Fax:314-257-3761
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMO199136839363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q37865Medicare UPIN
MO824312931Medicare ID - Type Unspecified
MO42927400Medicare ID - Type Unspecified