Provider Demographics
NPI:1932541232
Name:HENRY-CAMPBELL, DAWN (PN5175305)
Entity Type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:
Last Name:HENRY-CAMPBELL
Suffix:
Gender:F
Credentials:PN5175305
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:819 PENINSULAR DR
Mailing Address - Street 2:
Mailing Address - City:HAINES CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33844-5831
Mailing Address - Country:US
Mailing Address - Phone:917-273-9917
Mailing Address - Fax:
Practice Address - Street 1:525 AVENUE J NW
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33881-4047
Practice Address - Country:US
Practice Address - Phone:917-273-9917
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-27
Last Update Date:2013-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5175305164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse