1548567217 NPI number — MRS. STEPHANIE HAZEL CAMPBELL CLINICAL CERTIFICATI

Table of content: MRS. STEPHANIE HAZEL CAMPBELL CLINICAL CERTIFICATI (NPI 1548567217)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548567217 NPI number — MRS. STEPHANIE HAZEL CAMPBELL CLINICAL CERTIFICATI

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CAMPBELL
Provider First Name:
STEPHANIE
Provider Middle Name:
HAZEL
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CLINICAL CERTIFICATI
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PRITCHARD
Provider Other First Name:
STEPHANIE
Provider Other Middle Name:
HAZEL
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1548567217
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
DONAHUE AVENUE
Provider Second Line Business Mailing Address:
LAWRENCE PUBLIC SCHOOL
Provider Business Mailing Address City Name:
INWOOD
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11096
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-295-6200
Provider Business Mailing Address Fax Number:
516-295-6213

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
DONAHUE AVENUE
Provider Second Line Business Practice Location Address:
NUMBER TWO SCHOOL
Provider Business Practice Location Address City Name:
INWOOD
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11096
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-295-6200
Provider Business Practice Location Address Fax Number:
516-295-6213
Provider Enumeration Date:
02/16/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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