Provider Demographics
NPI:1972895506
Name:CAMPO, DEBRA LEE (MBA, MSN, RN)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:LEE
Last Name:CAMPO
Suffix:
Gender:F
Credentials:MBA, MSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 LONGWOOD AVENUE
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RHODE ISLAND
Mailing Address - Zip Code:02908
Mailing Address - Country:UM
Mailing Address - Phone:401-273-9188
Mailing Address - Fax:
Practice Address - Street 1:2 LONGWOOD AVE
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02908-1118
Practice Address - Country:US
Practice Address - Phone:401-273-9188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-16
Last Update Date:2011-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRN25280163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator