Provider Demographics
NPI:1336897529
Name:CAMPBELL, WILLONA CIARA
Entity Type:Individual
Prefix:
First Name:WILLONA
Middle Name:CIARA
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:WILLONA
Other - Middle Name:CIARA
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4513 CATALPA DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45405-5233
Mailing Address - Country:US
Mailing Address - Phone:937-567-0795
Mailing Address - Fax:
Practice Address - Street 1:4513 CATALPA DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45405-5233
Practice Address - Country:US
Practice Address - Phone:937-567-0795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-16
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty