Basic Information
Provider Information
NPI: 1083279491
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CAMPBELL
FirstName: ADRIANNE
MiddleName: M
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 203 N WASHINGTON ST STE 300
Address2:  
City: SPOKANE
State: WA
PostalCode: 992010254
CountryCode: US
TelephoneNumber: 5094448888
FaxNumber: 5094447806
Practice Location
Address1: 3919 N MAPLE ST
Address2:  
City: SPOKANE
State: WA
PostalCode: 992051349
CountryCode: US
TelephoneNumber: 5094448200
FaxNumber: 5094447806
Other Information
ProviderEnumerationDate: 05/01/2019
LastUpdateDate: 05/01/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363L00000XAP60956627WAY Physician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner 

No ID Information.


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