Provider Demographics
NPI:1790473924
Name:DANDRIDGE, CAMILLE ROSE (RN)
Entity Type:Individual
Prefix:
First Name:CAMILLE
Middle Name:ROSE
Last Name:DANDRIDGE
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 1:5610 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23225-2536
Mailing Address - Country:US
Mailing Address - Phone:804-614-6401
Mailing Address - Fax:
Practice Address - Street 1:5610 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23225-2536
Practice Address - Country:US
Practice Address - Phone:804-614-6401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-26
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001310331163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse