Provider Demographics
NPI:1750375366
Name:CAMPBELL, DEBORAH ANN (MSN)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:ANN
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:MSN
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:ANN
Other - Last Name:ROSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:927 MOUNT HOLLY DR
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21409-5123
Mailing Address - Country:US
Mailing Address - Phone:410-757-5544
Mailing Address - Fax:
Practice Address - Street 1:1238 PUTTY HILL AVE
Practice Address - Street 2:# 6
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-5844
Practice Address - Country:US
Practice Address - Phone:410-823-2726
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR063343363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD082NL970Medicare PIN
P48254Medicare UPIN
MD019242M72Medicare PIN