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General NPI Number Information
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NPI Number | 1417998519
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Entity Type | Individual
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Provider Name | MICHAEL DUANE CAMPBELL CRNA
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Gender | Male
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Dates
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Enumeration Date | 06/09/2006
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Last Update Date | 05/19/2008
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Provider Practice Location Address
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Address Line | 2601 FOX RUN PKWY
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City | YANKTON
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State | SD
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Zip | 57078-5341
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Country | US
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Telephone | 605-665-5100
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Fax | 605-665-5200
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Provider Business Mailing Address
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Address Line | 307 WALNUT ST SUITE C
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City | YANKTON
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State | SD
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Zip | 57078-4361
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Country | US
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Telephone | 605-664-5050
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Fax | 605-664-5051
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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 | R014863
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License Number State | SD
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 028203
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License Number State | SD
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