Healthcare Provider Details

I. General information

NPI: 1679228332
Provider Name (Legal Business Name): LISA ANN CAMPBELL FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2022
Last Update Date: 03/02/2022
Certification Date: 03/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 NEXUS DR STE NE3-100
WILMINGTON DE
19803-3000
US

IV. Provider business mailing address

4000 NEXUS DR STE NE3-100
WILMINGTON DE
19803-3000
US

V. Phone/Fax

Practice location:
  • Phone: 302-777-0643
  • Fax: 302-623-7964
Mailing address:
  • Phone: 302-777-0643
  • Fax: 302-623-7964

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberL1-0046662
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberLG-0011913
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: