Provider Information for 1659833788
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HOLLIE FAY CAMPBELL
Sex: Female
NPI: 1659833788
Last Updated: 2023-06-28
Certification Date: 2023-06-28
Certification Date: 2023-06-28
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1659833788 | ||||||||||||
| Enumeration Date | 2019-04-06 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | YES | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 13728 W CAREFREE DR HOMER GLEN, IL 60491-8655 United States Phone: 815-955-8725 | Fax: | ||||||||||||
| Primary Practice Address | 13728 W CAREFREE DR HOMER GLEN, IL 60491-8655 United States Phone: 708-507-5543 | Fax:708-966-4244 | ||||||||||||
| Secondary Practice Address(es) | 186 HOLBROOK RD | ||||||||||||
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