Provider Demographics
NPI:1851662480
Name:CAMPBELL, STEPHANIE (LPN)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1068 PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-4834
Mailing Address - Country:US
Mailing Address - Phone:419-973-7410
Mailing Address - Fax:
Practice Address - Street 1:1068 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-4834
Practice Address - Country:US
Practice Address - Phone:419-973-7410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-12
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN121802-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse