Provider Demographics
NPI:1598081580
Name:CAMPBELL, JULIE ANNE (CST, CSFA)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:ANNE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:CST, CSFA
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Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1000 HOUSTON STREET
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76102
Mailing Address - Country:US
Mailing Address - Phone:817-336-0551
Mailing Address - Fax:817-339-3940
Practice Address - Street 1:1000 HOUSTON STREET
Practice Address - Street 2:SUITE 200
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76102
Practice Address - Country:US
Practice Address - Phone:817-336-0551
Practice Address - Fax:817-339-3940
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-15
Last Update Date:2015-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX111445OtherNATIONAL CERTIFICATION