Provider Demographics
NPI:1104909563
Name:CAMPBELL, MARY KATTHERINE (RN)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:KATTHERINE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
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Mailing Address - Street 1:103 HERBERT DR
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-2186
Mailing Address - Country:US
Mailing Address - Phone:304-890-0263
Mailing Address - Fax:304-253-9569
Practice Address - Street 1:103 HERBERT DR
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-2186
Practice Address - Country:US
Practice Address - Phone:304-890-0263
Practice Address - Fax:304-253-9569
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WV011870332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies