Healthcare Provider Details

I. General information

NPI: 1760458434
Provider Name (Legal Business Name): SHIRLEY MAUREEN CAMPBELL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 01/19/2021
Certification Date: 01/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 S GRAND BLVD # 3B
SAINT LOUIS MO
63104-1016
US

IV. Provider business mailing address

1008 S SPRING AVE FL 2
SAINT LOUIS MO
63110-2520
US

V. Phone/Fax

Practice location:
  • Phone: 314-257-3760
  • Fax: 314-257-3761
Mailing address:
  • Phone: 314-977-2140
  • Fax: 314-977-1660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberMO199136839
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: