Provider Demographics
NPI:1548596810
Name:CAMPBELL, ERIN LINDSEY (PA-C LLC)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:LINDSEY
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:PA-C LLC
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:LINDSEY
Other - Last Name:BENJAMIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:PO BOX 506
Mailing Address - Street 2:
Mailing Address - City:NEWCASTLE
Mailing Address - State:CA
Mailing Address - Zip Code:95658-0506
Mailing Address - Country:US
Mailing Address - Phone:520-360-6080
Mailing Address - Fax:
Practice Address - Street 1:9192 LOS PUENTES RD
Practice Address - Street 2:
Practice Address - City:NEWCASTLE
Practice Address - State:CA
Practice Address - Zip Code:95658-9706
Practice Address - Country:US
Practice Address - Phone:520-360-6080
Practice Address - Fax:208-506-7953
Is Sole Proprietor?:No
Enumeration Date:2009-10-21
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54013363AS0400X
MI5601006061363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA54013OtherPHYSICIAN ASSISTANT SURGICAL
MI5601006061OtherLICENSE