Basic Information
| Provider Information | |||||||||
| NPI: | 1134628217 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CAMPBELL | ||||||||
| FirstName: | SALLY | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12910 PIERCE ST | ||||||||
| Address2: | STE 120 | ||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681441106 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4029333770 | ||||||||
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| Practice Location | |||||||||
| Address1: | 987400 NEBRASKA MEDICAL CENTER | ||||||||
| Address2: | |||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681987400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4025596637 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/05/2018 | ||||||||
| LastUpdateDate: | 08/24/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/24/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 2392 | NE | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363A00000X | 090692 | IA | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.