MEDICARE: SUE ANN CAMASO SALDEEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WC0200X	Critical Care Medicine Registered Nurse	RN1044452	DC

General Provider Information

NPI Number	:	1639669609
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUE ANN CAMASO SALDEEN

Provider Business Mailing Address
First Line	:	5527 EASTBOURNE DR
Second Line	:
City	:	SPRINGFIELD
State	:	VA
Zip	:	22151-1606
Country	:	US
Telephone Number	:	813-766-8183
Fax Number	:

Provider Business Practice Location Address
First Line	:	5527 EASTBOURNE DR
Second Line	:
City	:	SPRINGFIELD
State	:	VA
Zip	:	22151-1606
Country	:	US
Telephone Number	:	813-766-8183
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/15/2018
Last Update Date	:	05/15/2018

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