Provider Demographics
NPI:1801175179
Name:PERSONAL ANESTHESIA PC
Entity type:Organization
Organization Name:PERSONAL ANESTHESIA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:LAMMOT
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:303-506-1036
Mailing Address - Street 1:10210 LONGVIEW DR
Mailing Address - Street 2:
Mailing Address - City:LONETREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-9774
Mailing Address - Country:US
Mailing Address - Phone:303-506-1036
Mailing Address - Fax:720-294-0793
Practice Address - Street 1:10210 LONGVIEW DR
Practice Address - Street 2:
Practice Address - City:LONETREE
Practice Address - State:CO
Practice Address - Zip Code:80124-9774
Practice Address - Country:US
Practice Address - Phone:303-506-1036
Practice Address - Fax:720-294-0793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-04
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO039506367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty