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General NPI Number Information
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NPI Number | 1083348916
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Entity Type | Individual
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Provider Name | SARAH E CAMPBELL
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Gender | Female
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Dates
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Enumeration Date | 07/15/2022
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Last Update Date | 10/15/2022
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Provider Practice Location Address
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Address Line | 112 CHARLTON RD
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City | BALLSTON LAKE
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State | NY
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Zip | 12019-2547
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Country | US
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Telephone | 518-399-7723
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Fax |
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Provider Business Mailing Address
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Address Line | 112 CHARLTON RD
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City | BALLSTON LAKE
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State | NY
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Zip | 12019-2547
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Country | US
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Telephone | 518-399-7723
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 645103
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 350018
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License Number State | NY
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