Healthcare Provider Details

I. General information

NPI: 1790473924
Provider Name (Legal Business Name): CAMILLE ROSE DANDRIDGE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2023
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 LEE STREET PO BOX 800634
CHARLOTTESVILLE VA
22908
US

IV. Provider business mailing address

5610 RIVERSIDE DR
RICHMOND VA
23225-2536
US

V. Phone/Fax

Practice location:
  • Phone: 434-982-0655
  • Fax: 434-982-3972
Mailing address:
  • Phone: 804-614-6401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0024192438
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: