Provider Demographics
NPI:1093477143
Name:CAMPBELL, TONJA M (BSN, RN, CCM, WWCP)
Entity type:Individual
Prefix:
First Name:TONJA
Middle Name:M
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:BSN, RN, CCM, WWCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 244
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98041-0244
Mailing Address - Country:US
Mailing Address - Phone:206-321-5695
Mailing Address - Fax:253-252-8591
Practice Address - Street 1:15600 116TH AVE NE UNIT R3
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-4169
Practice Address - Country:US
Practice Address - Phone:206-320-5695
Practice Address - Fax:253-252-8591
Is Sole Proprietor?:No
Enumeration Date:2021-10-06
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00138413163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management