Provider Demographics
NPI:1578532768
Name:CAMPBELL, JANICE LYNNE (CRNA)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:LYNNE
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:PO BOX 212110
Mailing Address - Street 2:
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33421-2110
Mailing Address - Country:US
Mailing Address - Phone:877-204-5230
Mailing Address - Fax:561-204-5232
Practice Address - Street 1:1 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:TOWANDA
Practice Address - State:PA
Practice Address - Zip Code:18848-9710
Practice Address - Country:US
Practice Address - Phone:570-268-2333
Practice Address - Fax:570-265-5763
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS55402367500000X
NC6105367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200299000AMedicaid
KS200299000AMedicaid