Provider Demographics
NPI:1396736088
Name:CAMPBELL, CYNTHIA L (CRNA)
Entity type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:L
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:L
Other - Last Name:WASON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:825 5TH AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-4214
Mailing Address - Country:US
Mailing Address - Phone:717-262-9700
Mailing Address - Fax:717-262-9702
Practice Address - Street 1:10212 GOVERNOR LANE BLVD UNIT 1004
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:MD
Practice Address - Zip Code:21795
Practice Address - Country:US
Practice Address - Phone:301-733-4200
Practice Address - Fax:301-223-7121
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2018-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN326841L367500000X
MDR069233367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA050514OtherMEDICARE GROUP #
PAG920-0086/85XWCUOtherCAREFIRST
PAPEARLOtherHEALTH AMERICA
PA120420418OtherDEPT OF LABOR
PA253320OtherUNISON
PA25-1716306OtherFIRST HEALTH
PAP00458420OtherRAILROAD MEDICARE
PA25-1716306OtherHEALTHNET/TRICARE
PA50073154OtherCAPITAL BLUECROSS
PARN326841LOtherLICENSE
PA102084316 0003Medicaid
PAG920-0086/85XWCUOtherCAREFIRST