Healthcare Provider Details

I. General information

NPI: 1891772414
Provider Name (Legal Business Name): BETH LEGGETT CAMERON F.N.P
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BETH LEGGETT CAMERON DNP

II. Dates (important events)

Enumeration Date: 12/23/2005
Last Update Date: 07/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3640 COLONEL GLENN HWY 140 UNIVERSITY HALL, COLLEGE OF NURSING
DAYTON OH
45435-0001
US

IV. Provider business mailing address

3640 COLONEL GLENN HWY 140 UNIVERSITY HALL, COLLEGE OF NURSING
DAYTON OH
45435-0001
US

V. Phone/Fax

Practice location:
  • Phone: 937-775-2665
  • Fax: 937-775-4571
Mailing address:
  • Phone: 937-775-2665
  • Fax: 937-775-4571

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP-08387
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA-084182
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: