Provider Demographics
NPI:1093776833
Name:CAMPANELLA, CONSTANCE M (FNP)
Entity Type:Individual
Prefix:MRS
First Name:CONSTANCE
Middle Name:M
Last Name:CAMPANELLA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2625 HARLEM RD
Mailing Address - Street 2:SUITE 240
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14225-4031
Mailing Address - Country:US
Mailing Address - Phone:716-895-4400
Mailing Address - Fax:716-892-5510
Practice Address - Street 1:2625 HARLEM RD
Practice Address - Street 2:SUITE 240
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14225-4031
Practice Address - Country:US
Practice Address - Phone:716-895-4400
Practice Address - Fax:716-892-5510
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF332665363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0002724801OtherUNIVERA
NY9512859OtherINDEPENDENT HEALTH
NY000560990001OtherBLUE SHIELD OF WNY
NY00027248002OtherUNIVERA
NY02730683Medicaid
NY02730683Medicaid