Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 0024169226 | VA |
NPI | 1184999492 |
---|---|
Provider Name | Miss Stephanie Nora Camacho |
First Address | Chesapeake, VA 23320-6321 |
Second Address | Norfolk, VA 23507-1910 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2012 |
Last Update Date | 20/03/2012 |