MEDICARE: LISA M CAMPBELL RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WG0000X	General Practice Registered Nurse	519228	CA

General Provider Information

NPI Number	:	1417947607
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA M CAMPBELL RN

Provider Business Mailing Address
First Line	:	14 BELMONTE
Second Line	:
City	:	IRVINE
State	:	CA
Zip	:	92620-2701
Country	:	US
Telephone Number	:	949-552-0598
Fax Number	:	949-387-2185

Provider Business Practice Location Address
First Line	:	14 BELMONTE
Second Line	:
City	:	IRVINE
State	:	CA
Zip	:	92620-2701
Country	:	US
Telephone Number	:	949-552-0598
Fax Number	:	949-387-2185

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/27/2005
Last Update Date	:	07/08/2007

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