Basic Information
| Provider Information | |||||||||
| NPI: | 1649645250 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CAMPBELL | ||||||||
| FirstName: | CLAUDETTE | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | FNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 34 LENOX AVE | ||||||||
| Address2: | |||||||||
| City: | PLEASANTVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105703214 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9147475260 | ||||||||
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| Practice Location | |||||||||
| Address1: | 107 W 4TH ST | ||||||||
| Address2: | AMINISTRATION | ||||||||
| City: | MOUNT VERNON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105504002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9146997200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/08/2015 | ||||||||
| LastUpdateDate: | 12/08/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | F339394 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | F339394 | 01 | NY | LICENSE | OTHER | 6539701 | 01 | NY | REGISTRATION | OTHER |