Provider Demographics
NPI:1255524260
Name:CAMPO, STEPHEN A (RN)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:A
Last Name:CAMPO
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 GREENBRIAR CT
Mailing Address - Street 2:
Mailing Address - City:EAST ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14445-2214
Mailing Address - Country:US
Mailing Address - Phone:585-586-6851
Mailing Address - Fax:
Practice Address - Street 1:4 GREENBRIAR CT
Practice Address - Street 2:
Practice Address - City:EAST ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14445-2214
Practice Address - Country:US
Practice Address - Phone:585-586-6851
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-22
Last Update Date:2009-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY539102163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse