Healthcare Provider Details

I. General information

NPI: 1598885774
Provider Name (Legal Business Name): PAM LYNN CAMPBELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 N B ST
MADERA CA
93638-3219
US

IV. Provider business mailing address

4760 E HOLLAND AVE
FRESNO CA
93726-2915
US

V. Phone/Fax

Practice location:
  • Phone: 559-661-5194
  • Fax:
Mailing address:
  • Phone: 559-292-5343
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: