1700960952 NPI number — MRS. CHERYL LYNN CAMPBELL RN FNP

Table of content: MRS. CHERYL LYNN CAMPBELL RN FNP (NPI 1700960952)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700960952 NPI number — MRS. CHERYL LYNN CAMPBELL RN FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CAMPBELL
Provider First Name:
CHERYL
Provider Middle Name:
LYNN
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:
STASTNY
Provider Other First Name:
CHERYL
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN FNP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1700960952
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2701 HOSPITAL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VICTORIA
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77901
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
361-573-9181
Provider Business Mailing Address Fax Number:
361-582-5752

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2701 HOSPITAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VICTORIA
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-573-9181
Provider Business Practice Location Address Fax Number:
361-582-5752
Provider Enumeration Date:
10/24/2006

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: 363LF0000X , with the licence number:  667427 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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