Provider Demographics
NPI:1144885609
Name:CAMPBELL, ROSEZINA (OTHER)
Entity type:Individual
Prefix:
First Name:ROSEZINA
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:OTHER
Other - Prefix:MS
Other - First Name:ROSEZINA
Other - Middle Name:
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:STUDENT
Mailing Address - Street 1:4946 N 19TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53209-5759
Mailing Address - Country:US
Mailing Address - Phone:414-704-2751
Mailing Address - Fax:
Practice Address - Street 1:6001 W CENTER ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53210-2154
Practice Address - Country:US
Practice Address - Phone:414-704-2751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-09
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program