Provider Demographics
NPI:1487119863
Name:CAMPBELL, TRAMECA (CD)
Entity type:Individual
Prefix:
First Name:TRAMECA
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6421 CRICKLEWOOD GREEN LN
Mailing Address - Street 2:
Mailing Address - City:JAMESVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13078-8408
Mailing Address - Country:US
Mailing Address - Phone:315-418-2160
Mailing Address - Fax:
Practice Address - Street 1:6421 CRICKLEWOOD GREEN LN
Practice Address - Street 2:
Practice Address - City:JAMESVILLE
Practice Address - State:NY
Practice Address - Zip Code:13078-8408
Practice Address - Country:US
Practice Address - Phone:315-364-1440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-09
Last Update Date:2019-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY465675082Medicaid