Provider Demographics
NPI:1942389150
Name:CAMPO, DON (CHP, LMP, EFR)
Entity Type:Individual
Prefix:
First Name:DON
Middle Name:
Last Name:CAMPO
Suffix:
Gender:M
Credentials:CHP, LMP, EFR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16410 84TH ST NE
Mailing Address - Street 2:#D457
Mailing Address - City:LAKE STEVENS
Mailing Address - State:WA
Mailing Address - Zip Code:98258-9060
Mailing Address - Country:US
Mailing Address - Phone:425-308-9194
Mailing Address - Fax:
Practice Address - Street 1:10525 STATE AVE
Practice Address - Street 2:SUITE A
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98271-7216
Practice Address - Country:US
Practice Address - Phone:425-308-9194
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA00016332174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA154479OtherL & I
WA668492OtherABMP