Provider Demographics
NPI:1811235757
Name:CAMPBELL, VALERIE DENISE
Entity Type:Individual
Prefix:MS
First Name:VALERIE
Middle Name:DENISE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7033 BRECKEN TRCE
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30058-2975
Mailing Address - Country:US
Mailing Address - Phone:770-595-6102
Mailing Address - Fax:
Practice Address - Street 1:7033 BRECKEN TRCE
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30058-2975
Practice Address - Country:US
Practice Address - Phone:770-595-6102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-28
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN127153163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse