Healthcare Provider Details

I. General information

NPI: 1417947607
Provider Name (Legal Business Name): LISA M CAMPBELL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/27/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 BELMONTE
IRVINE CA
92620-2701
US

IV. Provider business mailing address

14 BELMONTE
IRVINE CA
92620-2701
US

V. Phone/Fax

Practice location:
  • Phone: 949-552-0598
  • Fax: 949-387-2185
Mailing address:
  • Phone: 949-552-0598
  • Fax: 949-387-2185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number519228
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: