Provider Demographics
NPI:1518415652
Name:CAMPBELL, ELIZABETH A (FNP)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 LORRIES LN
Mailing Address - Street 2:
Mailing Address - City:WHITESBORO
Mailing Address - State:NY
Mailing Address - Zip Code:13492-3228
Mailing Address - Country:US
Mailing Address - Phone:315-790-5975
Mailing Address - Fax:315-792-7555
Practice Address - Street 1:406 ELIZABETH ST
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13501-2306
Practice Address - Country:US
Practice Address - Phone:315-798-5748
Practice Address - Fax:315-798-1057
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-19
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY339154363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily