=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578095808
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JULIE ANN CAMPBELL MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/27/2017
-----------------------------------------------------
Last Update Date | 05/29/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1821 SOUTH AVE W
-----------------------------------------------------
City | MISSOULA
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59801-6517
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-493-0844
-----------------------------------------------------
Fax | 406-493-0841
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1821 SOUTH AVE W STE 202
-----------------------------------------------------
City | MISSOULA
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59801-6518
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-493-0844
-----------------------------------------------------
Fax | 406-493-0841
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | 60756607
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | MED-PHYS-LIC-102405
-----------------------------------------------------
License Number State | MT
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 2080P0216X
-----------------------------------------------------
Taxonomy Name | Pediatric Rheumatology Physician
-----------------------------------------------------
License Number | MD61059666
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 2080P0216X
-----------------------------------------------------
Taxonomy Name | Pediatric Rheumatology Physician
-----------------------------------------------------
License Number | MED-PHYS-LIC-102405
-----------------------------------------------------
License Number State | MT
-----------------------------------------------------