Provider Demographics
NPI:1427231893
Name:CAMPBELL, CYNTHIA TINA (LAC)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:TINA
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11830 NE 128TH ST STE 203
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-7202
Mailing Address - Country:US
Mailing Address - Phone:425-803-5033
Mailing Address - Fax:
Practice Address - Street 1:11830 NE 128TH ST STE 203
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-7202
Practice Address - Country:US
Practice Address - Phone:425-803-5033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-08
Last Update Date:2007-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAWA000245171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist