Provider Demographics
NPI:1679382543
Name:DE BORJA-CAMPBELL, LORRAINE JILL PANELO (FNP-C)
Entity type:Individual
Prefix:
First Name:LORRAINE JILL
Middle Name:PANELO
Last Name:DE BORJA-CAMPBELL
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:LORRAINE
Other - Middle Name:PANELO
Other - Last Name:DE BORJA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6604 DITMARS ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89166-8027
Mailing Address - Country:US
Mailing Address - Phone:702-219-3922
Mailing Address - Fax:
Practice Address - Street 1:6604 DITMARS ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89166-8027
Practice Address - Country:US
Practice Address - Phone:702-219-3922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-04
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV810316363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily