Provider Demographics
NPI:1235512971
Name:CAMPANELLI SPENCE, ALLYSON (DO)
Entity Type:Individual
Prefix:
First Name:ALLYSON
Middle Name:
Last Name:CAMPANELLI SPENCE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:ALLYSON
Other - Middle Name:
Other - Last Name:CAMPANELLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1322 3RD ST SE STE 240
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98372-3771
Mailing Address - Country:US
Mailing Address - Phone:253-697-1420
Mailing Address - Fax:253-697-1439
Practice Address - Street 1:1322 3RD ST SE STE 240
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-3771
Practice Address - Country:US
Practice Address - Phone:253-697-1420
Practice Address - Fax:253-697-1439
Is Sole Proprietor?:No
Enumeration Date:2015-06-30
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60670012207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine