Healthcare Provider Details

I. General information

NPI: 1417595331
Provider Name (Legal Business Name): CASEY MELISSA CAMPBELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2019
Last Update Date: 08/10/2021
Certification Date: 08/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

172 KINSLEY ST
NASHUA NH
03060-3648
US

IV. Provider business mailing address

242 GREEN ST
GARDNER MA
01440-1336
US

V. Phone/Fax

Practice location:
  • Phone: 603-882-3000
  • Fax:
Mailing address:
  • Phone: 978-632-3420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number074417-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: