Provider Demographics
NPI:1982835583
Name:CAMPBELL, LISA JANE (RN)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:JANE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 MURRAY RD.
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NV
Mailing Address - Zip Code:10940
Mailing Address - Country:US
Mailing Address - Phone:845-342-3614
Mailing Address - Fax:
Practice Address - Street 1:4 CEDAR CT
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940
Practice Address - Country:US
Practice Address - Phone:845-283-1392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-30
Last Update Date:2009-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY378762-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse