Provider Demographics
NPI:1932402682
Name:CAMPBELL, MARY (LPN)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2739 HWY 365 NORTH
Mailing Address - Street 2:
Mailing Address - City:REDFIELD
Mailing Address - State:AR
Mailing Address - Zip Code:72132
Mailing Address - Country:US
Mailing Address - Phone:870-550-3907
Mailing Address - Fax:
Practice Address - Street 1:2302 W. 28TH, SUITE A
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71603
Practice Address - Country:US
Practice Address - Phone:870-536-1400
Practice Address - Fax:870-536-5196
Is Sole Proprietor?:No
Enumeration Date:2010-12-17
Last Update Date:2010-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARL33861164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse