Provider Demographics
NPI:1760222723
Name:CAMPBELL, MARILYN (RN, NURSE EDUCATOR)
Entity type:Individual
Prefix:DR
First Name:MARILYN
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:RN, NURSE EDUCATOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2713 TENBROECK AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10469-5324
Mailing Address - Country:US
Mailing Address - Phone:646-709-9070
Mailing Address - Fax:
Practice Address - Street 1:2713 TENBROECK AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10469-5324
Practice Address - Country:US
Practice Address - Phone:646-709-9070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-28
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY640319163WC1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1600XNursing Service ProvidersRegistered NurseContinuing Education/Staff Development