Healthcare Provider Details

I. General information

NPI: 1073100186
Provider Name (Legal Business Name): REAVONNE S CAMPBELL LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2020
Last Update Date: 09/30/2025
Certification Date: 09/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

888 W LONG LAKE RD STE 225
TROY MI
48098-2827
US

IV. Provider business mailing address

888 W LONG LAKE RD STE 225
TROY MI
48098-2827
US

V. Phone/Fax

Practice location:
  • Phone: 800-443-2603
  • Fax: 800-443-0403
Mailing address:
  • Phone: 800-443-2603
  • Fax: 800-443-0403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number4703123184
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: