Provider Demographics
NPI:1255562310
Name:CAMP, KONIA A (LPN)
Entity type:Individual
Prefix:MRS
First Name:KONIA
Middle Name:A
Last Name:CAMP
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4513 EICHELBERGER AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45406-2429
Mailing Address - Country:US
Mailing Address - Phone:937-673-4399
Mailing Address - Fax:
Practice Address - Street 1:4513 EICHELBERGER AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45406-2429
Practice Address - Country:US
Practice Address - Phone:937-673-4399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-06
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN128999IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse