Basic Information
| Provider Information | |||||||||
| NPI: | 1205043262 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CAMPBELL | ||||||||
| FirstName: | BETHANIE | ||||||||
| MiddleName: | KRISTIN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 84858 | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981246158 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4254071500 | ||||||||
| FaxNumber: | 4254071112 | ||||||||
| Practice Location | |||||||||
| Address1: | 1550 N 115TH ST | ||||||||
| Address2: | MS B-250 | ||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981338401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2063681008 | ||||||||
| FaxNumber: | 2066259184 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2007 | ||||||||
| LastUpdateDate: | 03/01/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 2006-01921 | NC | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | MD60013224 | WA | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 8515553 | 05 | WA | MEDICAID |