Healthcare Provider Details

I. General information

NPI: 1144090259
Provider Name (Legal Business Name): SIMYRA CAMPBELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2024
Last Update Date: 01/09/2024
Certification Date: 01/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38 HULL ST
BROOKLYN NY
11233-2617
US

IV. Provider business mailing address

38 HULL ST
BROOKLYN NY
11233-2617
US

V. Phone/Fax

Practice location:
  • Phone: 267-259-2762
  • Fax:
Mailing address:
  • Phone: 267-259-2762
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License Number817502-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: