Provider Demographics
NPI:1699246298
Name:CAMPBELL, YVETTE (CERTIFIED HAIR LOSS)
Entity type:Individual
Prefix:
First Name:YVETTE
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:CERTIFIED HAIR LOSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 VERNON AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH BELLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:11710-1336
Mailing Address - Country:US
Mailing Address - Phone:347-740-7531
Mailing Address - Fax:
Practice Address - Street 1:730 VERNON AVE
Practice Address - Street 2:
Practice Address - City:NORTH BELLMORE
Practice Address - State:NY
Practice Address - Zip Code:11710-1336
Practice Address - Country:US
Practice Address - Phone:347-740-7531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-09
Last Update Date:2018-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY10434561744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management