Healthcare Provider Details

I. General information

NPI: 1356941751
Provider Name (Legal Business Name): MARIE B CAMPBELL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2020
Last Update Date: 08/18/2022
Certification Date: 08/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 NORTH ST
BATAVIA NY
14020-1631
US

IV. Provider business mailing address

100 KINGS HWY S
ROCHESTER NY
14617-5504
US

V. Phone/Fax

Practice location:
  • Phone: 585-344-5201
  • Fax: 585-344-7352
Mailing address:
  • Phone: 585-344-5201
  • Fax: 585-344-7352

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number309909
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: