Healthcare Provider Details

I. General information

NPI: 1194881482
Provider Name (Legal Business Name): TERENA GRACE CAMPBELL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HEIDELBERG MEDDAC CMR 442
APO AE
09042
DE

IV. Provider business mailing address

CREDENTIALS OFFICE CMR 442
APO AE
09042
DE

V. Phone/Fax

Practice location:
  • Phone: 496221172274
  • Fax: 496221172941
Mailing address:
  • Phone: 496221172274
  • Fax: 496221172941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License Number121739
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: