Provider Demographics
NPI:1871922161
Name:CAMPBELL, ZACHARY A (NP)
Entity type:Individual
Prefix:
First Name:ZACHARY
Middle Name:A
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5450 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-2709
Mailing Address - Country:US
Mailing Address - Phone:303-415-5199
Mailing Address - Fax:303-415-5198
Practice Address - Street 1:6685 GUNPARK DR
Practice Address - Street 2:SUITE 102
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-3388
Practice Address - Country:US
Practice Address - Phone:303-415-5199
Practice Address - Fax:303-415-5198
Is Sole Proprietor?:No
Enumeration Date:2013-11-06
Last Update Date:2017-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0990942-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily