Provider Demographics
NPI:1730417072
Name:CAMPBELL-LEWIS, JESSICA CHARLOTTE (RN)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:CHARLOTTE
Last Name:CAMPBELL-LEWIS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:JESSICA
Other - Middle Name:CHARLOTTE
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:3680 BEECHWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14304-1482
Mailing Address - Country:US
Mailing Address - Phone:716-523-6824
Mailing Address - Fax:716-297-8260
Practice Address - Street 1:3680 BEECHWOOD CIR
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14304-1482
Practice Address - Country:US
Practice Address - Phone:716-523-6824
Practice Address - Fax:716-297-8260
Is Sole Proprietor?:No
Enumeration Date:2009-11-25
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY299380-1164W00000X
NY634745163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No163W00000XNursing Service ProvidersRegistered Nurse