Provider Demographics
NPI:1972736999
Name:CAMPBELL, DIANA EDWARDS
Entity Type:Individual
Prefix:MS
First Name:DIANA
Middle Name:EDWARDS
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 474
Mailing Address - Street 2:
Mailing Address - City:PALMER LAKE
Mailing Address - State:CO
Mailing Address - Zip Code:80133-0474
Mailing Address - Country:US
Mailing Address - Phone:719-488-5677
Mailing Address - Fax:719-488-9445
Practice Address - Street 1:281 PINECREST WAY
Practice Address - Street 2:
Practice Address - City:PALMER LAKE
Practice Address - State:CO
Practice Address - Zip Code:80133-0474
Practice Address - Country:US
Practice Address - Phone:719-648-3925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-25
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant