Provider Demographics
NPI:1033587845
Name:CAMPBELL, JOSIE (DO)
Entity Type:Individual
Prefix:
First Name:JOSIE
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 S JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:RITZVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:99169-2106
Mailing Address - Country:US
Mailing Address - Phone:509-659-1600
Mailing Address - Fax:509-659-1317
Practice Address - Street 1:506 S JACKSON ST
Practice Address - Street 2:
Practice Address - City:RITZVILLE
Practice Address - State:WA
Practice Address - Zip Code:99169-2106
Practice Address - Country:US
Practice Address - Phone:509-659-1600
Practice Address - Fax:509-659-1317
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-10
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA603-462-445314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA47-2632481OtherTAX ID
WA2044700Medicaid
TN50-5282OtherMEDICARE PTAN