Provider Demographics
NPI:1972363646
Name:CAMPER, VIVIAN NICOLE (BA)
Entity Type:Individual
Prefix:
First Name:VIVIAN
Middle Name:NICOLE
Last Name:CAMPER
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1893 N SWAINSON AVE
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-4112
Mailing Address - Country:US
Mailing Address - Phone:503-812-2198
Mailing Address - Fax:
Practice Address - Street 1:6305 W OVERLAND RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83709-3029
Practice Address - Country:US
Practice Address - Phone:208-605-3663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-20
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health