Provider Demographics
NPI:1831833201
Name:CAMPBELL, MYCHEAL ROCHELLE
Entity type:Individual
Prefix:MRS
First Name:MYCHEAL
Middle Name:ROCHELLE
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 1:1728 TENNYSON AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45406-4050
Mailing Address - Country:US
Mailing Address - Phone:937-718-3649
Mailing Address - Fax:
Practice Address - Street 1:1728 TENNYSON AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45406-4050
Practice Address - Country:US
Practice Address - Phone:937-718-3649
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-22
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0477344Medicaid