Provider Demographics
NPI:1528284197
Name:CAMPAGNA, BRUCE DAVID
Entity type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:DAVID
Last Name:CAMPAGNA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:524 S GREEN RIVER RD
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47715-7308
Mailing Address - Country:US
Mailing Address - Phone:812-473-6630
Mailing Address - Fax:812-402-6734
Practice Address - Street 1:524 S GREEN RIVER RD
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-7308
Practice Address - Country:US
Practice Address - Phone:812-473-6630
Practice Address - Fax:812-402-6734
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ININ17000891A237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist