Healthcare Provider Details

I. General information

NPI: 1346811726
Provider Name (Legal Business Name): CHRISTOPHER ROBERT CAMPBELL REGISTERED NURSE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2021
Last Update Date: 07/07/2021
Certification Date: 07/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 FLORIDA AVE
MODESTO CA
95350-4404
US

IV. Provider business mailing address

5908 JANDEE WAY
RIVERBANK CA
95367-9528
US

V. Phone/Fax

Practice location:
  • Phone: 209-578-1211
  • Fax:
Mailing address:
  • Phone: 209-605-7396
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95064628
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: