Provider Demographics
NPI:1740842921
Name:CAMPBELL, CARRIE (APRN FNP-C)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:APRN FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3792 DRIFTWOOD RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-3450
Mailing Address - Country:US
Mailing Address - Phone:419-290-0600
Mailing Address - Fax:
Practice Address - Street 1:1261 N TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162-3368
Practice Address - Country:US
Practice Address - Phone:734-457-2142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-08
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.025197363LF0000X
OH301903363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily