Provider Demographics
NPI:1891247441
Name:CAMPBELL, AMBER (CNP)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:
Other - Last Name:JENNINGS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:700 N COLUMBUS ST
Mailing Address - Street 2:
Mailing Address - City:CRESTLINE
Mailing Address - State:OH
Mailing Address - Zip Code:44827-1455
Mailing Address - Country:US
Mailing Address - Phone:419-529-6195
Mailing Address - Fax:419-529-9187
Practice Address - Street 1:715 RICHLAND MALL
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:OH
Practice Address - Zip Code:44906-3802
Practice Address - Country:US
Practice Address - Phone:419-529-6195
Practice Address - Fax:419-529-9187
Is Sole Proprietor?:No
Enumeration Date:2016-10-31
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.019967363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0149428Medicaid