Provider Demographics
NPI:1417998519
Name:CAMPBELL, MICHAEL DUANE (CRNA)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:DUANE
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 WALNUT ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:YANKTON
Mailing Address - State:SD
Mailing Address - Zip Code:57078-4361
Mailing Address - Country:US
Mailing Address - Phone:605-664-5050
Mailing Address - Fax:605-664-5051
Practice Address - Street 1:2601 FOX RUN PKWY
Practice Address - Street 2:
Practice Address - City:YANKTON
Practice Address - State:SD
Practice Address - Zip Code:57078-5341
Practice Address - Country:US
Practice Address - Phone:605-665-5100
Practice Address - Fax:605-665-5200
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDR014863163W00000X
SD028203367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN204788800Medicaid
R014863OtherDAKOTACARE
2002926OtherMEDICA
0040296OtherWELLMARK BLUE CROSS BLUE
241494OtherMIDLANDS CHOICE
SD5750212Medicaid
NE02058492200Medicaid
SD23163OtherSANFORD HEALTH PLAN
SDP00046848OtherRAILROAD
R014863OtherDAKOTACARE