Basic Information
Provider Information
NPI: 1093019945
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CAMPBELL
FirstName: SHARON
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: CRNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 500 UPPER CHESAPEAKE DR
Address2:  
City: BEL AIR
State: MD
PostalCode: 210144324
CountryCode: US
TelephoneNumber: 4436431500
FaxNumber: 4436431505
Practice Location
Address1: 500 UPPER CHESAPEAKE DR
Address2:  
City: BEL AIR
State: MD
PostalCode: 210144324
CountryCode: US
TelephoneNumber: 4436431500
FaxNumber: 4436431505
Other Information
ProviderEnumerationDate: 01/07/2011
LastUpdateDate: 01/23/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 01/23/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LA2100XR118455MDY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care

No ID Information.


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