Provider Demographics
NPI:1780703892
Name:CAMPBELL, MARY HELEN
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:HELEN
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7800 PHOENIX AVE NE
Mailing Address - Street 2:SUITE #C
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-3719
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7800 PHOENIX AVE NE
Practice Address - Street 2:SUITE #C
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-3719
Practice Address - Country:US
Practice Address - Phone:505-299-3003
Practice Address - Fax:505-299-3012
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM77033531Medicaid