Healthcare Provider Details

I. General information

NPI: 1578607974
Provider Name (Legal Business Name): MARILYN GREENE CAMPBELL CPM-TN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/18/2007
Last Update Date: 12/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

326 BOWWOOD DR
NASHVILLE TN
37217-2302
US

IV. Provider business mailing address

326 BOWWOOD DR
NASHVILLE TN
37217-2302
US

V. Phone/Fax

Practice location:
  • Phone: 615-848-5557
  • Fax:
Mailing address:
  • Phone: 615-848-5557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberCPM0000000005
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: