Provider Demographics
NPI:1154414902
Name:CAMPBELL, ANNIE (PA)
Entity type:Individual
Prefix:
First Name:ANNIE
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:190 E BANNOCK ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83712-6241
Mailing Address - Country:US
Mailing Address - Phone:208-381-7190
Mailing Address - Fax:208-381-7191
Practice Address - Street 1:333 N 1ST ST
Practice Address - Street 2:SUITE 120
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-6100
Practice Address - Country:US
Practice Address - Phone:208-381-7190
Practice Address - Fax:208-381-7191
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2017-09-27
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant