Provider Demographics
NPI:1023142684
Name:CAMPBELL, ROSE MARIE (CNP)
Entity type:Individual
Prefix:
First Name:ROSE
Middle Name:MARIE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:323 MARION AVE NW
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44646-3639
Mailing Address - Country:US
Mailing Address - Phone:330-837-1111
Mailing Address - Fax:330-837-1769
Practice Address - Street 1:323 MARION AVE NW
Practice Address - Street 2:SUITE 200
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44646-3639
Practice Address - Country:US
Practice Address - Phone:330-837-1111
Practice Address - Fax:330-837-1769
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP-09126363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2753382Medicaid
OH4793Medicare PIN