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General NPI Number Information
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NPI Number | 1053474262
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Entity Type | Individual
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Provider Name | ELOISE CAMPBELL NP,CDE,BC-ADM
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Gender | Female
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Dates
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Enumeration Date | 12/18/2006
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Last Update Date | 08/08/2013
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Provider Practice Location Address
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Address Line | 920 DUPONT RD
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City | LOUISVILLE
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State | KY
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Zip | 40207-4692
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Country | US
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Telephone | 502-895-2334
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Fax | 502-896-6987
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Provider Business Mailing Address
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Address Line | 3306 BREAUX DR
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City | LOUISVILLE
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State | KY
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Zip | 40220-2113
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 3003087
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 71001251A
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License Number State | IN
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