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General NPI Number Information
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NPI Number | 1942402532
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Entity Type | Individual
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Provider Name | MARY JANE CAMPBELL CPNP
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Gender | Female
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Dates
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Enumeration Date | 06/05/2007
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Last Update Date | 05/06/2010
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Provider Practice Location Address
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Address Line | 12655 N CENTRAL EXPY SUITE 300
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City | DALLAS
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State | TX
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Zip | 75243-1700
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Country | US
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Telephone | 972-788-1858
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Fax | 972-788-2798
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Provider Business Mailing Address
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Address Line | 12655 N CENTRAL EXPY SUITE 300
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City | DALLAS
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State | TX
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Zip | 75243-1700
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Country | US
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Telephone | 972-788-1858
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Fax | 972-788-2798
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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 | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 501269
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License Number State | TX
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