Provider Demographics
NPI:1750762142
Name:CAMPBELL, AMELIA MAE (AGPCNP-BC)
Entity type:Individual
Prefix:
First Name:AMELIA
Middle Name:MAE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 E MCDOWELL RD
Mailing Address - Street 2:STE 100
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-2605
Mailing Address - Country:US
Mailing Address - Phone:602-254-6879
Mailing Address - Fax:602-265-8151
Practice Address - Street 1:3035 S ELLSWORTH RD
Practice Address - Street 2:SUITE 135
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85212-2160
Practice Address - Country:US
Practice Address - Phone:623-295-4906
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-11
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP7868363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner