Healthcare Provider Details

I. General information

NPI: 1205043262
Provider Name (Legal Business Name): BETHANIE KRISTIN CAMPBELL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 03/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 N 115TH ST MS B-250
SEATTLE WA
98133-8401
US

IV. Provider business mailing address

PO BOX 84858
SEATTLE WA
98124-6158
US

V. Phone/Fax

Practice location:
  • Phone: 206-368-1008
  • Fax: 206-625-9184
Mailing address:
  • Phone: 425-407-1500
  • Fax: 425-407-1112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number2006-01921
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD60013224
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: