Healthcare Provider Details

I. General information

NPI: 1346321577
Provider Name (Legal Business Name): MARY SUSAN CAMPBELL FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY SUSAN PIRTLE

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 05/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 SW COAST HWY SUITE 203
NEWPORT OR
97365-5288
US

IV. Provider business mailing address

1010 SW COAST HWY STE 203
NEWPORT OR
97365-5215
US

V. Phone/Fax

Practice location:
  • Phone: 541-265-4947
  • Fax: 541-574-7670
Mailing address:
  • Phone: 573-210-1010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number137448
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209015842
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number201600925NP-PP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: