Individual
NICOLE M CAMPBELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
1700 E 19TH ST, THE DALLES, OR 97058
(541) 296-7760
Mailing address
PO BOX 69355, BALTIMORE, MD 21264-9355
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
201500184CRNA
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
201500184CRNA
STATE
OR
01
—
NR14585000
STATE LICENSE
NJ
Enumeration date
12/30/2009
Last updated
07/01/2022
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