Provider Demographics
NPI:1760377717
Name:CAMPBELL, KATRINA ANN
Entity type:Individual
Prefix:
First Name:KATRINA
Middle Name:ANN
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 E SHERMAN AVE
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-4044
Mailing Address - Country:US
Mailing Address - Phone:208-966-4206
Mailing Address - Fax:208-966-4220
Practice Address - Street 1:1400 E SHERMAN AVE
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-4044
Practice Address - Country:US
Practice Address - Phone:208-966-4206
Practice Address - Fax:208-966-4220
Is Sole Proprietor?:No
Enumeration Date:2025-06-10
Last Update Date:2025-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program