Provider Demographics
NPI:1730306457
Name:CAMPBELL, DEBRA L (PA-C)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:L
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:L
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:6981 LITTLEROCK RD SW # WW
Mailing Address - Street 2:
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98512-7226
Mailing Address - Country:US
Mailing Address - Phone:360-943-3633
Mailing Address - Fax:
Practice Address - Street 1:6981 LITTLEROCK RD SW
Practice Address - Street 2:SUITE 101
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98512-7226
Practice Address - Country:US
Practice Address - Phone:360-943-3633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10004981363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
G8895283OtherPTAN
UT000055335Medicare PIN
VA017318C63Medicare PIN