Provider Demographics
NPI:1295915486
Name:CAMPBELL, GRACE ELIZABETH
Entity type:Individual
Prefix:MS
First Name:GRACE
Middle Name:ELIZABETH
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 1:10 BLUFF DR
Mailing Address - Street 2:
Mailing Address - City:LYMAN
Mailing Address - State:ME
Mailing Address - Zip Code:04002-6734
Mailing Address - Country:US
Mailing Address - Phone:207-423-0549
Mailing Address - Fax:
Practice Address - Street 1:421 POMPANO TER
Practice Address - Street 2:
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33950-2841
Practice Address - Country:US
Practice Address - Phone:207-423-0549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-06
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist