MEDICARE: CYNTHIA LYNN CAMPBELL FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	852049924405	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	852049924405	OTHER	UT	UTAH STATE LICENSE NUMBER

General Provider Information

NPI Number	:	1134112998
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CYNTHIA LYNN CAMPBELL FNP

Provider Business Mailing Address
First Line	:	292 E 300 N
Second Line	:
City	:	MIDWAY
State	:	UT
Zip	:	84049-6917
Country	:	US
Telephone Number	:	435-654-2285
Fax Number	:

Provider Business Practice Location Address
First Line	:	728 W 100 S STE 1
Second Line	:
City	:	HEBER CITY
State	:	UT
Zip	:	84032-3764
Country	:	US
Telephone Number	:	435-654-4067
Fax Number	:	435-654-4192

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/26/2005
Last Update Date	:	11/18/2010

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