Provider Demographics
NPI:1881621969
Name:CAMPBELL, MICHELE L (RD LDN)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:L
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:RD LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1579 LOWER CHRISTOFF ST
Mailing Address - Street 2:
Mailing Address - City:NANTY GLO
Mailing Address - State:PA
Mailing Address - Zip Code:15943-1235
Mailing Address - Country:US
Mailing Address - Phone:814-615-3225
Mailing Address - Fax:
Practice Address - Street 1:835 HOSPITAL ROAD
Practice Address - Street 2:DIETITIAN
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701-0788
Practice Address - Country:US
Practice Address - Phone:724-357-7164
Practice Address - Fax:724-357-7247
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN002890133V00000X
PADN 002890133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA097619GU9Medicare ID - Type Unspecified