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General NPI Number Information
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NPI Number | 1104507268
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Entity Type | Individual
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Provider Name | AMY MARIE CAMPBELL
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Gender | Female
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Dates
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Enumeration Date | 07/31/2023
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Last Update Date | 10/06/2025
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Provider Practice Location Address
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Address Line | 1477 S STATE RD
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City | DAVISON
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State | MI
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Zip | 48423-1911
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Country | US
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Telephone | 799-581-0564
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Fax |
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Provider Business Mailing Address
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Address Line | 1967 HOWLAND BLVD
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City | WHITE LAKE
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State | MI
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Zip | 48386-1857
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Country | US
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Telephone | 586-707-3305
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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