Healthcare Provider Details

I. General information

NPI: 1265949358
Provider Name (Legal Business Name): ALLIE CAMPO APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2018
Last Update Date: 11/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 TRENTON RD
BROWNS MILLS NJ
08015
US

IV. Provider business mailing address

200 TRENTON RD
BROWNS MILLS NJ
08015-1764
US

V. Phone/Fax

Practice location:
  • Phone: 609-283-1200
  • Fax: 609-893-6038
Mailing address:
  • Phone: 609-283-1200
  • Fax: 609-893-6038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number26NJ00793500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: