1033375837 NPI number — MRS. ANNE CATHERINE CAMPBELL RN, FNP

Table of content: MRS. ANNE CATHERINE CAMPBELL RN, FNP (NPI 1033375837)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033375837 NPI number — MRS. ANNE CATHERINE CAMPBELL RN, FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CAMPBELL
Provider First Name:
ANNE
Provider Middle Name:
CATHERINE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RN, FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HANSON
Provider Other First Name:
ANNE
Provider Other Middle Name:
CATHERINE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN, FNP-BC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1033375837
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/12/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
127 E STATE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GLOVERSVILLE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12078-1297
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-773-7931
Provider Business Mailing Address Fax Number:
518-736-3933

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
LEXINGTON CENTER
Provider Second Line Business Practice Location Address:
127 EAST STATE STREET
Provider Business Practice Location Address City Name:
GLOVERSVILLE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12078
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-773-7931
Provider Business Practice Location Address Fax Number:
518-736-3933
Provider Enumeration Date:
07/31/2008

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: 363LF0000X , with the licence number:  338518 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 03818499 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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