Provider Demographics
NPI:1134112998
Name:CAMPBELL, CYNTHIA LYNN (FNP)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:LYNN
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:292 E 300 N
Mailing Address - Street 2:
Mailing Address - City:MIDWAY
Mailing Address - State:UT
Mailing Address - Zip Code:84049-6917
Mailing Address - Country:US
Mailing Address - Phone:435-654-2285
Mailing Address - Fax:
Practice Address - Street 1:728 W 100 S STE 1
Practice Address - Street 2:
Practice Address - City:HEBER CITY
Practice Address - State:UT
Practice Address - Zip Code:84032-3764
Practice Address - Country:US
Practice Address - Phone:435-654-4067
Practice Address - Fax:435-654-4192
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2010-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT852049924405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT852049924405OtherUTAH STATE LICENSE NUMBER
UTS57930Medicare UPIN
UT852049924405OtherUTAH STATE LICENSE NUMBER