1760575872 NPI number — JANE VANCAMPEN CRNA

Table of content: JANE VANCAMPEN CRNA (NPI 1760575872)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760575872 NPI number — JANE VANCAMPEN CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VANCAMPEN
Provider First Name:
JANE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1760575872
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/11/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
76 PEACHTREE ROAD
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
ASHEVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28803-3505
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-274-3477
Provider Business Mailing Address Fax Number:
828-274-7407

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
76 PEACHTREE ROAD
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
ASHEVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28803-3505
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-274-3477
Provider Business Practice Location Address Fax Number:
828-274-7407
Provider Enumeration Date:
10/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  032674 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 260848B . This is a "CIGNA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 8000180 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 235131E . This is a "SWAIN CRNA CIGNA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 430050489 . This is a "HARRIS RR" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 8000315 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 430079569 . This is a "SWAIN RR" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 260557 . This is a "HARRIS CRNA CIGNA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 70387 . This is a "LICENSE NUMBER" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 8050375 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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