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General NPI Number Information
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NPI Number | 1639573785
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Entity Type | Individual
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Provider Name | EVAN JOSEPH CAMPHOR RN
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Gender | Male
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Dates
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Enumeration Date | 10/17/2014
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Last Update Date | 11/06/2026
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Provider Practice Location Address
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Address Line | 2064 LILAC ARBOR WAY
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City | DACULA
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State | GA
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Zip | 30019-2475
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Country | US
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Telephone | 510-332-2270
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Fax |
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Provider Business Mailing Address
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Address Line | 2064 LILAC ARBOR WAY
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City | DACULA
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State | GA
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Zip | 30019-2475
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Country | US
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Telephone | 510-332-2270
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WE0003X
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Taxonomy Name | Emergency Registered Nurse
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License Number | RN173052
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License Number State | GA
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