Provider Demographics
NPI:1447611157
Name:CAMPBELL, HOLLY (MSM, LM, CPM)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:MSM, LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20696 BOND RD NE
Mailing Address - Street 2:BLDG C, STE 110
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-9015
Mailing Address - Country:US
Mailing Address - Phone:360-779-0004
Mailing Address - Fax:206-260-1261
Practice Address - Street 1:20696 BOND RD NE
Practice Address - Street 2:BLDG C, STE 110
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-9015
Practice Address - Country:US
Practice Address - Phone:360-779-0004
Practice Address - Fax:206-260-1261
Is Sole Proprietor?:No
Enumeration Date:2016-03-09
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMW60682419176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife