Provider Demographics
NPI:1730704727
Name:CAMPBELL, SHILOH
Entity type:Individual
Prefix:
First Name:SHILOH
Middle Name:
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:PO BOX 3510
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15230-3510
Mailing Address - Country:US
Mailing Address - Phone:412-288-2130
Mailing Address - Fax:
Practice Address - Street 1:3292 STATE ROUTE 257
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:PA
Practice Address - Zip Code:16346-2530
Practice Address - Country:US
Practice Address - Phone:814-676-1811
Practice Address - Fax:814-677-3091
Is Sole Proprietor?:No
Enumeration Date:2020-06-15
Last Update Date:2021-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP022012363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily