Basic Information
| Provider Information | |||||||||
| NPI: | 1225337348 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CAMPBELL | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | LEIGH | ||||||||
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| Credential: | R.N. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 51760 US HIGHWAY 31 | ||||||||
| Address2: | |||||||||
| City: | BAY MINETTE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 365077670 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2513794615 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 372 GREENO RD S | ||||||||
| Address2: | |||||||||
| City: | FAIRHOPE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 365321916 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2519282871 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/16/2011 | ||||||||
| LastUpdateDate: | 03/16/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 1-128182 | AL | Y | Nursing Service Providers | Registered Nurse |
No ID Information.