Provider Demographics
NPI:1871035550
Name:CAMPANA, LAUREEN (NP)
Entity Type:Individual
Prefix:
First Name:LAUREEN
Middle Name:
Last Name:CAMPANA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21684 LONGEWAY RD
Mailing Address - Street 2:
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-8989
Mailing Address - Country:US
Mailing Address - Phone:209-585-7152
Mailing Address - Fax:
Practice Address - Street 1:21684 LONGEWAY RD
Practice Address - Street 2:
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-8989
Practice Address - Country:US
Practice Address - Phone:209-585-7152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-10
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN 344256363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care