Provider Demographics
NPI:1689664229
Name:CAMPBELL, CAROL (ACNP)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 SEYMOUR ST
Mailing Address - Street 2:SUITE 719
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106-5501
Mailing Address - Country:US
Mailing Address - Phone:860-522-0604
Mailing Address - Fax:860-522-1761
Practice Address - Street 1:85 SEYMOUR ST
Practice Address - Street 2:SUITE 719
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-5501
Practice Address - Country:US
Practice Address - Phone:860-522-0604
Practice Address - Fax:860-522-1761
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0000936363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTCA7937OtherRAILROAD MEDICARE GROUP #
CT004194966Medicaid
CT500022800OtherRAILROAD MEDICARE
CTCA7937OtherRAILROAD MEDICARE GROUP #
CT004194966Medicaid