Provider Demographics
NPI:1386274256
Name:CAMPAGNA-SHIVERS, ELISSA LYNN (ATHLETIC TRAINER)
Entity type:Individual
Prefix:
First Name:ELISSA
Middle Name:LYNN
Last Name:CAMPAGNA-SHIVERS
Suffix:
Gender:F
Credentials:ATHLETIC TRAINER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 W 1ST ST STE 300
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45402-1111
Mailing Address - Country:US
Mailing Address - Phone:937-223-5201
Mailing Address - Fax:
Practice Address - Street 1:4515 COSGRAY RD
Practice Address - Street 2:
Practice Address - City:HILLIARD
Practice Address - State:OH
Practice Address - Zip Code:43026-7787
Practice Address - Country:US
Practice Address - Phone:614-334-9622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-20
Last Update Date:2020-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator