Provider Demographics
NPI:1548886690
Name:CAMPBELL, CHRISTINE JOY
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:JOY
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58598 OLD VANCE TRL
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81403-7958
Mailing Address - Country:US
Mailing Address - Phone:970-417-0938
Mailing Address - Fax:
Practice Address - Street 1:702 S 5TH ST
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-5713
Practice Address - Country:US
Practice Address - Phone:970-596-9953
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-24
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NA.00790148376K00000X
CONA.00790148376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide