Provider Demographics
NPI:1386616282
Name:CAMPBELL, GAIL
Entity type:Individual
Prefix:
First Name:GAIL
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 ARMSTRONG RD
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:CT
Mailing Address - Zip Code:06484
Mailing Address - Country:US
Mailing Address - Phone:203-929-7353
Mailing Address - Fax:203-929-0756
Practice Address - Street 1:2800 MAIN ST
Practice Address - Street 2:ST VINCENTS MEDICAL CENTER
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606
Practice Address - Country:US
Practice Address - Phone:203-929-7353
Practice Address - Fax:203-929-0756
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000328367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004081725Medicaid
430000091Medicare ID - Type Unspecified