Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 0024174393 | VA |
NPI | 1003354473 |
---|---|
Provider Name | Mrs. Brandi Campbell |
First Address | Manassas, VA 20112-3422 |
Second Address | Manassas, VA 20112-3422 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2017 |
Last Update Date | 06/02/2017 |