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General NPI Number Information
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NPI Number | 1235384157
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Entity Type | Individual
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Provider Name | CHRISTINE CAMPBELL MVP
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Gender | Female
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Dates
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Enumeration Date | 11/19/2008
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Last Update Date | 11/19/2008
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Provider Practice Location Address
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Address Line | 15685 SCOTTY LANE
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City | YOUGSTOWN
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State | FL
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Zip | 32466
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Country | US
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Telephone | 850-722-9047
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Fax | 850-722-9047
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Provider Business Mailing Address
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Address Line | 15685 SCOTTY LN
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City | YOUNGSTOWN
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State | FL
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Zip | 32466-1702
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Country | US
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Telephone | 850-722-9047
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Fax | 850-722-9047
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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 | 372500000X
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Taxonomy Name | Chore Provider
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License Number | CNA29590
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 3747P1801X
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Taxonomy Name | Personal Care Attendant
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License Number | CNA2950
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 376K00000X
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Taxonomy Name | Nurse's Aide
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License Number | CNA29590
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License Number State | FL
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