MEDICARE: STEPHANIE JULIET CAMPBELL, DO, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician

General Provider Information

NPI Number	:	1629640693
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEPHANIE JULIET CAMPBELL, DO, LLC

Provider Business Mailing Address
First Line	:	706 NE EVANS ST
Second Line	:
City	:	MCMINNVILLE
State	:	OR
Zip	:	97128-3926
Country	:	US
Telephone Number	:	503-472-1405
Fax Number	:	503-434-5950

Provider Business Practice Location Address
First Line	:	706 NE EVANS ST
Second Line	:
City	:	MCMINNVILLE
State	:	OR
Zip	:	97128-3926
Country	:	US
Telephone Number	:	808-498-6617
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PHYSICIAN
Name	:	DR. STEPHANIE JULIET CAMPBELL
Credential	:	DO
Telephone Number	:	503-472-1405

Provider Enumeration Date	:	07/11/2021
Last Update Date	:	06/16/2022

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