STACIE B CAMPBELL
Physician Assistant


Address: 646 Anderson Ave., New York, NY 10024

STACIE B CAMPBELL (Credential# 743421) is licensed (Physician Assistant) with Connecticut Department of Consumer Protection. The license effective date is September 1, 2005. The license expiration date date is September 30, 2006. The license status is INACTIVE.

Business Overview

STACIE B CAMPBELL is licensed with the Department of Consumer Protection of Connecticut. The credential number is #23.001672. The credential type is physician assistant. The effective date is September 1, 2005. The expiration date is September 30, 2006. The business address is 646 Anderson Ave., New York, NY 10024. The current status is inactive.

Basic Information

Licensee Name STACIE B CAMPBELL
Credential ID 743421
Credential Number 23.001672
Credential Type Physician Assistant
Business Address 646 Anderson Ave.
New York
NY 10024
Business Type INDIVIDUAL
Status INACTIVE - LAPSED DUE TO NON-RENEWAL
Issue Date 2005-09-01
Effective Date 2005-09-01
Expiration Date 2006-09-30
Refresh Date 2009-07-08

Office Location

Street Address 646 Anderson Ave.
City New York
State NY
Zip Code 10024

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City New York
Zip Code 10024
License Type Physician Assistant
License Type + County Physician Assistant + New York

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Dataset Information

Data Provider Connecticut Department of Consumer Protection
Jurisdiction Connecticut
Related Datasets Connecticut Business Registrations, Connecticut Child Care Facilities

This dataset includes 1.41 million licenses issued wtih Connecticut Department of Consumer Protection (TDLR).

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