Healthcare Provider Details

I. General information

NPI: 1538635594
Provider Name (Legal Business Name): KIMBERLY CAMPBELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2018
Last Update Date: 10/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 STEEPLECHASE LN
MONROE OH
45050-2441
US

IV. Provider business mailing address

280 STEEPLECHASE LN
MONROE OH
45050-2441
US

V. Phone/Fax

Practice location:
  • Phone: 513-571-5091
  • Fax:
Mailing address:
  • Phone: 513-571-5091
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number372020680495
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: