Healthcare Provider Details

I. General information

NPI: 1346156585
Provider Name (Legal Business Name): MARISSA CAMPO CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2240 RIDGEWOOD RD STE 100
WYOMISSING PA
19610-1286
US

IV. Provider business mailing address

2240 RIDGEWOOD RD STE 100 SUITE 100
WYOMISSING PA
19610-1286
US

V. Phone/Fax

Practice location:
  • Phone: 610-376-8698
  • Fax: 610-376-8745
Mailing address:
  • Phone: 610-376-8698
  • Fax: 610-376-8745

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberSP036795
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: