Healthcare Provider Details

I. General information

NPI: 1386903243
Provider Name (Legal Business Name): KARLENE D CAMPBELL R.N
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2012
Last Update Date: 05/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 LIVONIA AVE
BROOKLYN NY
11207
US

IV. Provider business mailing address

720 LIVONIA AVE
BROOKLYN NY
11207
US

V. Phone/Fax

Practice location:
  • Phone: 718-498-1190
  • Fax: 718-345-2170
Mailing address:
  • Phone: 718-498-1190
  • Fax: 718-345-2170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number453854
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: