Healthcare Provider Details

I. General information

NPI: 1659696201
Provider Name (Legal Business Name): CHARLENE M CAMPBELL L.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MS. CHARLENE M WHEATLEY

II. Dates (important events)

Enumeration Date: 04/06/2010
Last Update Date: 04/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3805 136TH PL SE
BELLEVUE WA
98006-1407
US

IV. Provider business mailing address

3805 136TH PL SE
BELLEVUE WA
98006-1407
US

V. Phone/Fax

Practice location:
  • Phone: 425-246-3265
  • Fax: 425-957-0907
Mailing address:
  • Phone: 425-246-3265
  • Fax: 425-957-0907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberMW 60104546
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: