Provider Demographics
NPI:1154913911
Name:CAMPBELL, EMILY GRACE (RN)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:GRACE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:474 OIL WL UNIT B
Mailing Address - Street 2:
Mailing Address - City:PIPE CREEK
Mailing Address - State:TX
Mailing Address - Zip Code:78063-6674
Mailing Address - Country:US
Mailing Address - Phone:210-517-8749
Mailing Address - Fax:
Practice Address - Street 1:474 OIL WL UNIT B
Practice Address - Street 2:
Practice Address - City:PIPE CREEK
Practice Address - State:TX
Practice Address - Zip Code:78063-6674
Practice Address - Country:US
Practice Address - Phone:210-517-8749
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-03
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX973109163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics