Provider Demographics
NPI:1912240490
Name:CAMPOS, ELSI LORENA (RN)
Entity Type:Individual
Prefix:
First Name:ELSI
Middle Name:LORENA
Last Name:CAMPOS
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 1:9709 DORVAL AVE
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-4407
Mailing Address - Country:US
Mailing Address - Phone:240-643-3889
Mailing Address - Fax:
Practice Address - Street 1:8630 FENTON ST
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-3806
Practice Address - Country:US
Practice Address - Phone:301-340-7525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-03
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR187956163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse