Provider Demographics
NPI:1457104515
Name:CAMPBELL, AMANDA (BS, RN, CPD)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:BS, RN, CPD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 MEADOWBROOK RD
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:PA
Mailing Address - Zip Code:16148-2682
Mailing Address - Country:US
Mailing Address - Phone:814-577-9075
Mailing Address - Fax:
Practice Address - Street 1:2200 MEMORIAL DRIVE
Practice Address - Street 2:
Practice Address - City:FARRELL
Practice Address - State:PA
Practice Address - Zip Code:16121
Practice Address - Country:US
Practice Address - Phone:724-981-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-09
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN761984163W00000X
PA374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No163W00000XNursing Service ProvidersRegistered Nurse