Provider Demographics
NPI:1851056501
Name:CAMPBELL, JULIANA MARIE (LPN)
Entity type:Individual
Prefix:
First Name:JULIANA
Middle Name:MARIE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15520 SW BEEF BEND RD
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224-1165
Mailing Address - Country:US
Mailing Address - Phone:503-686-3008
Mailing Address - Fax:
Practice Address - Street 1:625 OKANOGAN AVE
Practice Address - Street 2:
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-6409
Practice Address - Country:US
Practice Address - Phone:503-686-3008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-07
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201130406LPN164W00000X
ID61420164W00000X
WALP60300349164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse