Healthcare Provider Details

I. General information

NPI: 1336882778
Provider Name (Legal Business Name): SAMANTHA CAMPBELL ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2022
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2426 N MERRITT CREEK LOOP STE A
COEUR D ALENE ID
83814-4961
US

IV. Provider business mailing address

8419 W RED AVE
CHENEY WA
99004-4029
US

V. Phone/Fax

Practice location:
  • Phone: 208-819-2183
  • Fax:
Mailing address:
  • Phone: 360-402-9394
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP61272329
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: