Provider Demographics
NPI:1821402520
Name:CAMPBELL, VANESSA NOEL (DO)
Entity Type:Individual
Prefix:DR
First Name:VANESSA
Middle Name:NOEL
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 ATWOOD SQ # 3
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02130-3115
Mailing Address - Country:US
Mailing Address - Phone:303-902-3959
Mailing Address - Fax:
Practice Address - Street 1:1390 KELLY JOHNSON BLVD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-3908
Practice Address - Country:US
Practice Address - Phone:719-795-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-20
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.00650972085R0202X
MI51010211352085R0202X
MI51510095032085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology