Individual
CHRISTY GRACE CAMPBELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMP
Contact information
Practice address
5110 LACKEY ROAD KP N, VAUGHN, WA 98394-9663
(253) 884-2144
(253) 884-5293
Mailing address
8903 KEY PENINSULA HWY N, LAKEBAY, WA 98349-9326
(253) 820-8060
(253) 884-2632
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
MA00013232
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0131876
LABOR AND INDUSTRIES
WA
01
—
1047CA
REGENCEBLUESHIELD
WA
Enumeration date
05/13/2007
Last updated
02/12/2015
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