Healthcare Provider Details

I. General information

NPI: 1245475409
Provider Name (Legal Business Name): MRS. ROSEALEE WHITE CAMPBELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MISS ROSEALEE WHITE

II. Dates (important events)

Enumeration Date: 12/02/2008
Last Update Date: 12/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3026 INDIANA AVE
NASHVILLE TN
37209-3809
US

IV. Provider business mailing address

3026 INDIANA AVE
NASHVILLE TN
37209-3809
US

V. Phone/Fax

Practice location:
  • Phone: 615-340-0824
  • Fax:
Mailing address:
  • Phone: 615-340-0824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: