Provider Demographics
NPI:1790906212
Name:CAMPBELL, PAMELA SUE (RD, LDN, CDE)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:SUE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:RD, LDN, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3822 COLONIAL AVE
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16506-3826
Mailing Address - Country:US
Mailing Address - Phone:814-835-2626
Mailing Address - Fax:814-835-2646
Practice Address - Street 1:3822 COLONIAL AVE
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16506-3826
Practice Address - Country:US
Practice Address - Phone:814-835-2626
Practice Address - Fax:814-835-2646
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN001078133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered