Provider Demographics
NPI:1053886051
Name:CAMPBELL, ADRIAN DENISE
Entity type:Individual
Prefix:
First Name:ADRIAN
Middle Name:DENISE
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 1:493 WESTERLY RD
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44307-2027
Mailing Address - Country:US
Mailing Address - Phone:330-256-5097
Mailing Address - Fax:330-400-4051
Practice Address - Street 1:493 WESTERLY RD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44307-2027
Practice Address - Country:US
Practice Address - Phone:330-256-5097
Practice Address - Fax:330-400-4051
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-05
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2463730Medicaid