Provider Demographics
NPI:1316978752
Name:CAMPBELL, CAROLYN SUE II (CNP)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:SUE
Last Name:CAMPBELL
Suffix:II
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1145 STORYBROOK DR
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON COURT HOUSE
Mailing Address - State:OH
Mailing Address - Zip Code:43160-2602
Mailing Address - Country:US
Mailing Address - Phone:740-335-3892
Mailing Address - Fax:740-335-5395
Practice Address - Street 1:1227 US RTE 22 SOUTH WEST
Practice Address - Street 2:
Practice Address - City:WASHINGTON CH
Practice Address - State:OH
Practice Address - Zip Code:43160
Practice Address - Country:US
Practice Address - Phone:740-333-3310
Practice Address - Fax:740-333-3310
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP-04143363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Not Answered363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily