Provider Demographics
NPI:1770329096
Name:TISH CAMPBELL, LLC
Entity type:Organization
Organization Name:TISH CAMPBELL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FUNCTIONAL NUTRITIONIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LATISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, CNS
Authorized Official - Phone:503-260-4076
Mailing Address - Street 1:91-1245 FRANKLIN D ROOSEVELT AVE APT 319
Mailing Address - Street 2:
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96707-2177
Mailing Address - Country:US
Mailing Address - Phone:503-260-4076
Mailing Address - Fax:
Practice Address - Street 1:91-1245 FRANKLIN D ROOSEVELT AVE APT 319
Practice Address - Street 2:
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707-2177
Practice Address - Country:US
Practice Address - Phone:503-260-4076
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-05
Last Update Date:2024-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist