Basic Information
| Provider Information | |||||||||
| NPI: | 1740476605 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CAMPBELL | ||||||||
| FirstName: | SHERRI | ||||||||
| MiddleName: | N | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 252 CHAPMAN RD | ||||||||
| Address2: | SUITE 150 | ||||||||
| City: | NEWARK | ||||||||
| State: | DE | ||||||||
| PostalCode: | 197025438 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3023667665 | ||||||||
| FaxNumber: | 3023660734 | ||||||||
| Practice Location | |||||||||
| Address1: | 3105 LIMESTONE RD | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | WILMINGTON | ||||||||
| State: | DE | ||||||||
| PostalCode: | 198082151 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3029946500 | ||||||||
| FaxNumber: | 3029946922 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/24/2007 | ||||||||
| LastUpdateDate: | 11/09/2011 | ||||||||
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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 | 363AM0700X | C50000323 | DE | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
ID Information
| ID | Type | State | Issuer | Description | 1740476605 | 05 | DE | MEDICAID |