Doctor Name: | BRYCE CAMPBELL |
NPI Number: | 1023417037 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | NP-1475A |
Business Practice Address: | 450 E Main St Rexburg, ID - 83440 |
Business Phone Number: | 2083596900 |
Business Fax Number: | |
Mailing Address: | 450 E Main St, REXBURG |
State: | ID |
Postal Code: | 834402048 |
Phone Number: | 2083596900 |
Fax Number: | |
NPI Enumeration Date: | 08/14/2014 |
NPI Last Update Date: | 08/14/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | NP-1475A |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | ID |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |