Healthcare Provider Details

I. General information

NPI: 1255390969
Provider Name (Legal Business Name): BRIAN D. CAMPBELL CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2006
Last Update Date: 08/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 HIGHLAND AVE
WINCHESTER MA
01890-1446
US

IV. Provider business mailing address

14 TOWNSEND ST
MALDEN MA
02148-6323
US

V. Phone/Fax

Practice location:
  • Phone: 781-756-2012
  • Fax: 781-756-2975
Mailing address:
  • Phone: 781-397-8906
  • Fax: 781-397-1686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number145986
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: