Healthcare Provider Details

I. General information

NPI: 1922771138
Provider Name (Legal Business Name): CATHERINE CAMPBELL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2021
Last Update Date: 11/17/2022
Certification Date: 11/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 PROVIDENCE GLEN DR
CHAPEL HILL NC
27514-6993
US

IV. Provider business mailing address

311 PROVIDENCE GLEN DR
CHAPEL HILL NC
27514-6993
US

V. Phone/Fax

Practice location:
  • Phone: 704-534-0360
  • Fax:
Mailing address:
  • Phone: 704-534-0360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License Number295094
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number295094
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: