Provider Demographics
NPI:1891837035
Name:CAMPBELL, BRENDA LONG (REGISERED NURSE)
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:LONG
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:REGISERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4349 N 32ND WAY
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-3973
Mailing Address - Country:US
Mailing Address - Phone:602-957-0824
Mailing Address - Fax:
Practice Address - Street 1:4703 E INDIAN SCHOOL RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-5417
Practice Address - Country:US
Practice Address - Phone:480-484-6311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN 018014163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZRN018014OtherREGISTERED NURSE