Provider Demographics
NPI:1659696201
Name:CAMPBELL, CHARLENE M (LM)
Entity Type:Individual
Prefix:MRS
First Name:CHARLENE
Middle Name:M
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:LM
Other - Prefix:MS
Other - First Name:CHARLENE
Other - Middle Name:M
Other - Last Name:WHEATLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3805 136TH PL SE
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98006-1407
Mailing Address - Country:US
Mailing Address - Phone:425-246-3265
Mailing Address - Fax:425-957-0907
Practice Address - Street 1:3805 136TH PL SE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98006-1407
Practice Address - Country:US
Practice Address - Phone:425-246-3265
Practice Address - Fax:425-957-0907
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-06
Last Update Date:2010-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMW 60104546176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife