Provider Demographics
NPI:1104467042
Name:CAMPOS, ANGELINA SUZANNE (NP)
Entity type:Individual
Prefix:
First Name:ANGELINA
Middle Name:SUZANNE
Last Name:CAMPOS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5615 DUNBARTON AVE
Mailing Address - Street 2:
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-8216
Mailing Address - Country:US
Mailing Address - Phone:509-222-1275
Mailing Address - Fax:509-491-3031
Practice Address - Street 1:8400 OSUNA RD NE STE 2D
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-2069
Practice Address - Country:US
Practice Address - Phone:877-522-1275
Practice Address - Fax:509-491-3031
Is Sole Proprietor?:No
Enumeration Date:2019-10-02
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRN-75622163W00000X
WAAP61145506163WA0400X, 363L00000X
NM58262363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)