Provider Demographics
NPI:1851597215
Name:CAMPBELL, CHRISTIE ELIZABETH (DO)
Entity Type:Individual
Prefix:
First Name:CHRISTIE
Middle Name:ELIZABETH
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 9428
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-1428
Mailing Address - Country:US
Mailing Address - Phone:707-797-7335
Mailing Address - Fax:717-324-6731
Practice Address - Street 1:1410 NEOTOMAS AVE STE 102
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405
Practice Address - Country:US
Practice Address - Phone:707-797-7335
Practice Address - Fax:707-324-6731
Is Sole Proprietor?:No
Enumeration Date:2007-06-22
Last Update Date:2018-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11422208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5922055Medicaid
NCNC8620BMedicare PIN