Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 12940 | MT |
NPI | 1003186677 |
---|---|
Provider Name | Carla Campbell |
First Address | Butte, MT 59701-2870 |
Second Address | Butte, MT 59701-1703 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/01/2012 |
Last Update Date | 20/12/2018 |