Healthcare Provider Details

I. General information

NPI: 1558690115
Provider Name (Legal Business Name): DEBRA E CAMPBELL MSN, CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2009
Last Update Date: 10/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

544 W PERSHING RD
DECATUR IL
62526-3226
US

IV. Provider business mailing address

544 W PERSHING RD
DECATUR IL
62526-3226
US

V. Phone/Fax

Practice location:
  • Phone: 217-872-2400
  • Fax: 217-875-4680
Mailing address:
  • Phone: 217-872-2400
  • Fax: 217-875-4680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number209007790
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: