MEDICARE: DR. MARILYN CAMPBELL RN, NURSE EDUCATOR

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	163WC1600X	Continuing Education/Staff Development Registered Nurse	640319	NY

General Provider Information

NPI Number	:	1760222723
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARILYN CAMPBELL RN, NURSE EDUCATOR

Provider Business Mailing Address
First Line	:	2713 TENBROECK AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10469-5324
Country	:	US
Telephone Number	:	646-709-9070
Fax Number	:

Provider Business Practice Location Address
First Line	:	2713 TENBROECK AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10469-5324
Country	:	US
Telephone Number	:	646-709-9070
Fax Number	:

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

Provider Enumeration Date	:	05/28/2024
Last Update Date	:	05/28/2024

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