Healthcare Provider Details

I. General information

NPI: 1306770391
Provider Name (Legal Business Name): CHRISTINE M CAMPBELL RN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

745 WILLIAMS ST
MOSSYROCK WA
98564-9004
US

IV. Provider business mailing address

350 W BELDEN AVE APT 511
CHICAGO IL
60614-6312
US

V. Phone/Fax

Practice location:
  • Phone: 360-496-6003
  • Fax:
Mailing address:
  • Phone: 630-306-3602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN.RN.70129355
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: