Healthcare Provider Details

I. General information

NPI: 1477841997
Provider Name (Legal Business Name): CAMPBELL SHARPE PETERSON CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CAMPBELL DORIS SHARPE CRNA

II. Dates (important events)

Enumeration Date: 07/18/2011
Last Update Date: 06/09/2020
Certification Date: 06/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 WESTERN AVE SUITE 102
ALBANY NY
12203-3539
US

IV. Provider business mailing address

1450 WESTERN AVE SUITE 102
ALBANY NY
12203-3539
US

V. Phone/Fax

Practice location:
  • Phone: 919-271-9856
  • Fax:
Mailing address:
  • Phone: 919-271-9856
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number713311
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: