Provider Demographics
NPI:1003882796
Name:CAMPBELL, LORRIE-JEANNE (CRNA)
Entity Type:Individual
Prefix:
First Name:LORRIE-JEANNE
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 BROOKLINE AVE
Mailing Address - Street 2:DEPT. OF ANESTHESIA
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215
Mailing Address - Country:US
Mailing Address - Phone:617-667-3110
Mailing Address - Fax:617-667-5013
Practice Address - Street 1:330 BROOKLINE AVE
Practice Address - Street 2:DEPT. OF ANESTHESIA
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215
Practice Address - Country:US
Practice Address - Phone:617-667-3110
Practice Address - Fax:617-667-5013
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA207482367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NA0693Medicare ID - Type Unspecified
S47307Medicare UPIN