Healthcare Provider Details

I. General information

NPI: 1770418352
Provider Name (Legal Business Name): LAINA CELIA CAMPOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1137 POST RD E
WESTPORT CT
06880-5433
US

IV. Provider business mailing address

1 GREYROCK PL APT 4006
STAMFORD CT
06901-3141
US

V. Phone/Fax

Practice location:
  • Phone: 203-644-4507
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number17873
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: