Provider Demographics
NPI:1548666159
Name:CAMPBELL, KATHRYN E (CRNA)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:E
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:
Other - Last Name:STAUFFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8119 FURTADO DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28411-9486
Mailing Address - Country:US
Mailing Address - Phone:818-294-2433
Mailing Address - Fax:
Practice Address - Street 1:1801 S 17TH ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-6443
Practice Address - Country:US
Practice Address - Phone:910-763-4555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-08
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA728073163W00000X
CA103090367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse