Provider Demographics
NPI:1205847415
Name:CAMPBELL, NEDINE P (FNP)
Entity Type:Individual
Prefix:
First Name:NEDINE
Middle Name:P
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:NEDINE
Other - Middle Name:M
Other - Last Name:POTTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:1040 NW 22ND AVE
Mailing Address - Street 2:STE 330
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-3057
Mailing Address - Country:US
Mailing Address - Phone:503-274-9936
Mailing Address - Fax:503-274-2660
Practice Address - Street 1:1040 NW 22ND AVE
Practice Address - Street 2:STE 330
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-3057
Practice Address - Country:US
Practice Address - Phone:503-274-9936
Practice Address - Fax:503-274-2660
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR088006060N1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily