Provider Demographics
NPI:1982169702
Name:CAMPBELL, HANNA (PA-C)
Entity Type:Individual
Prefix:
First Name:HANNA
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:HANNA
Other - Middle Name:
Other - Last Name:ROBERGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:366 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WESTBROOK
Mailing Address - State:ME
Mailing Address - Zip Code:04092-4325
Mailing Address - Country:US
Mailing Address - Phone:603-707-7078
Mailing Address - Fax:
Practice Address - Street 1:16 CONCOURSE W
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-6007
Practice Address - Country:US
Practice Address - Phone:207-873-1036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-06
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA1891363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant