Provider Demographics
NPI:1881151215
Name:CAMPBELL, BARBARA JEAN (LPN)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:JEAN
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:BARBARA
Other - Middle Name:JEAN
Other - Last Name:FISHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:470 OLD ORCHARD DR APT 9
Mailing Address - Street 2:
Mailing Address - City:ESSEXVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48732-9644
Mailing Address - Country:US
Mailing Address - Phone:248-659-7268
Mailing Address - Fax:
Practice Address - Street 1:470 OLD ORCHARD DR APT 9
Practice Address - Street 2:
Practice Address - City:ESSEXVILLE
Practice Address - State:MI
Practice Address - Zip Code:48732-9644
Practice Address - Country:US
Practice Address - Phone:248-659-7268
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-21
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703022995164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4703022995OtherLICENSE