Healthcare Provider Details

I. General information

NPI: 1669207734
Provider Name (Legal Business Name): MEDCHRONOLOGY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2024
Last Update Date: 04/05/2026
Certification Date: 04/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 BROADWAY
EVERETT WA
98201-1719
US

IV. Provider business mailing address

1425 BROADWAY
EVERETT WA
98201-1719
US

V. Phone/Fax

Practice location:
  • Phone: 425-222-2190
  • Fax: 425-272-2895
Mailing address:
  • Phone: 425-222-2190
  • Fax: 425-272-2895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. CHRISTINE DIANNE CAMPBELL
Title or Position: CLINICIAN
Credential: APRN
Phone: 425-222-2190