Provider Demographics
NPI:1619703261
Name:CAMPBELL, MARK JR (DNP)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:CAMPBELL
Suffix:JR
Gender:M
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3111 N 31ST AVE UNIT A
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85017-5410
Mailing Address - Country:US
Mailing Address - Phone:602-314-7681
Mailing Address - Fax:
Practice Address - Street 1:3111 N 31ST AVE UNIT A
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85017-5410
Practice Address - Country:US
Practice Address - Phone:602-314-7681
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-10
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ309722363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health