Healthcare Provider Details

I. General information

NPI: 1417998519
Provider Name (Legal Business Name): MICHAEL DUANE CAMPBELL CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 05/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 FOX RUN PKWY
YANKTON SD
57078-5341
US

IV. Provider business mailing address

307 WALNUT ST SUITE C
YANKTON SD
57078-4361
US

V. Phone/Fax

Practice location:
  • Phone: 605-665-5100
  • Fax: 605-665-5200
Mailing address:
  • Phone: 605-664-5050
  • Fax: 605-664-5051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR014863
License Number StateSD
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number028203
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: