Provider Demographics
NPI:1992841043
Name:CAMPBELL, AMBER (ARNP)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2612 YELM HWY SE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98501-4826
Mailing Address - Country:US
Mailing Address - Phone:360-507-8146
Mailing Address - Fax:360-839-2852
Practice Address - Street 1:2612 YELM HWY SE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98501-4826
Practice Address - Country:US
Practice Address - Phone:206-390-4341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30007527363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9653072Medicaid
WAG8870942Medicare PIN
WAG8867948Medicare PIN
WAG8870941Medicare PIN
WAG8872472Medicare PIN
WAG8870943Medicare PIN