Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 0024170534 | VA |
NPI | 1003156407 |
---|---|
Provider Name | Susan Brien Campbell |
First Address | Charlotte, NC 28260-0447 |
Second Address | Manassas, VA 20110-4418 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2013 |
Last Update Date | 25/10/2020 |