MEDICARE: BREANNA CAMPBELL LPN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164X00000X	Licensed Vocational Nurse	LPN105633	GA

General Provider Information

NPI Number	:	1114874799
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BREANNA CAMPBELL LPN

Provider Business Mailing Address
First Line	:	3 MAUI CT
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31906
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3 MAUI CT
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31906-4407
Country	:	US
Telephone Number	:	706-405-8924
Fax Number	:	706-405-8924

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/12/2026
Last Update Date	:	03/12/2026

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Directions to “ BREANNA CAMPBELL LPN” Practice Location

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