Healthcare Provider Details

I. General information

NPI: 1043801244
Provider Name (Legal Business Name): SHERON CAMPBELL CCNS, ACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2021
Last Update Date: 01/29/2021
Certification Date: 01/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 DEWITT LOOP
FORT BELVOIR VA
22060-5285
US

IV. Provider business mailing address

5821 PETERSON LOOP
FORT BELVOIR VA
22060-2010
US

V. Phone/Fax

Practice location:
  • Phone: 703-582-8985
  • Fax:
Mailing address:
  • Phone: 703-582-8985
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2100X
TaxonomyAcute Care Clinical Nurse Specialist
License Number0015001052
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: