1902412901 NPI number — MS. OAKLEY CHRISTINE CAMPBELL MSW

Table of content: MS. OAKLEY CHRISTINE CAMPBELL MSW (NPI 1902412901)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902412901 NPI number — MS. OAKLEY CHRISTINE CAMPBELL MSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CAMPBELL
Provider First Name:
OAKLEY
Provider Middle Name:
CHRISTINE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1902412901
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/16/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
GIBAULT CARE, INC
Provider Second Line Business Mailing Address:
6401 S. US HWY 41
Provider Business Mailing Address City Name:
TERRE HAUTE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47802-4749
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-299-1156
Provider Business Mailing Address Fax Number:
812-298-3109

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
GIBAULT CARE, INC
Provider Second Line Business Practice Location Address:
6401 S. US HWY 41
Provider Business Practice Location Address City Name:
TERRE HAUTE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47802-4749
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-299-1156
Provider Business Practice Location Address Fax Number:
812-298-3109
Provider Enumeration Date:
09/16/2020

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: 104100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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