Provider Demographics
NPI:1952133175
Name:CAMPBELL, ALAN DALE
Entity type:Individual
Prefix:MR
First Name:ALAN
Middle Name:DALE
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1909 PROVINCETOWN RD
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON TOWNSHIP
Mailing Address - State:OH
Mailing Address - Zip Code:45459-3439
Mailing Address - Country:US
Mailing Address - Phone:228-219-4312
Mailing Address - Fax:
Practice Address - Street 1:1909 PROVINCETOWN RD
Practice Address - Street 2:
Practice Address - City:WASHINGTON TOWNSHIP
Practice Address - State:OH
Practice Address - Zip Code:45459-3439
Practice Address - Country:US
Practice Address - Phone:228-219-4312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-16
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker