Provider Demographics
NPI:1104134923
Name:CAMP, SUSAN ESTELLE (ARNP)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:ESTELLE
Last Name:CAMP
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 1:2700 EVERGREEN PKWY NW
Mailing Address - Street 2:SEMINAR 1-2110
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98505-0001
Mailing Address - Country:US
Mailing Address - Phone:360-867-5834
Mailing Address - Fax:360-867-6787
Practice Address - Street 1:2700 EVERGREEN PKWY NW
Practice Address - Street 2:SEMINAR 1-2110
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98505-0001
Practice Address - Country:US
Practice Address - Phone:360-867-5834
Practice Address - Fax:360-867-6787
Is Sole Proprietor?:No
Enumeration Date:2010-09-14
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00090270163W00000X
WAAP30002318363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse