Provider Demographics
NPI:1649645250
Name:CAMPBELL, CLAUDETTE A (FNP-BC)
Entity type:Individual
Prefix:
First Name:CLAUDETTE
Middle Name:A
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 LENOX AVE
Mailing Address - Street 2:
Mailing Address - City:PLEASANTVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10570-3214
Mailing Address - Country:US
Mailing Address - Phone:914-747-5260
Mailing Address - Fax:
Practice Address - Street 1:107 W 4TH ST
Practice Address - Street 2:AMINISTRATION
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10550-4002
Practice Address - Country:US
Practice Address - Phone:914-699-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-08
Last Update Date:2015-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF339394363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF339394OtherLICENSE
NY6539701OtherREGISTRATION