Provider Demographics
NPI:1760684187
Name:KAMPORORO, MARIE (RN)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:KAMPORORO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5443 KETTERING SQUARE DR N
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45440-2901
Mailing Address - Country:US
Mailing Address - Phone:937-432-9668
Mailing Address - Fax:
Practice Address - Street 1:5443 KETTERING SQUARE DR N
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45440-2901
Practice Address - Country:US
Practice Address - Phone:937-432-9668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN 332397163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse