Healthcare Provider Details

I. General information

NPI: 1013912773
Provider Name (Legal Business Name): GRIFFON CAMPBELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2005
Last Update Date: 04/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 SUDDERTH DR
RUIDOSO NM
88345-6002
US

IV. Provider business mailing address

PO BOX 2795
SILVER CITY NM
88062-2795
US

V. Phone/Fax

Practice location:
  • Phone: 575-999-9999
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR13894
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: