Provider Demographics
NPI:1306479084
Name:MORRISON CAMPBELL, COLLEEN
Entity type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:
Last Name:MORRISON CAMPBELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 RED OAK RD
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06606-1429
Mailing Address - Country:US
Mailing Address - Phone:862-220-3397
Mailing Address - Fax:475-449-9681
Practice Address - Street 1:126 RED OAK RD
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606-1429
Practice Address - Country:US
Practice Address - Phone:862-220-3397
Practice Address - Fax:475-449-9681
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-20
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000006675080251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health