Healthcare Provider Details

I. General information

NPI: 1295203818
Provider Name (Legal Business Name): TINA CAMERON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2018
Last Update Date: 11/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BERKELEY COUNTY BOARD OF EDUCATION 1453 WINCHESTER AVENUE
MARTINSBURG WV
25403
US

IV. Provider business mailing address

BERKELEY COUNTY BOARD OF EDUCATION 1453 WINCHESTER AVENUE
MARTINSBURG WV
25403
US

V. Phone/Fax

Practice location:
  • Phone: 304-267-3595
  • Fax: 304-267-3599
Mailing address:
  • Phone: 304-267-3595
  • Fax: 304-267-3599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number50310
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: