Provider Demographics
NPI:1598076010
Name:KAMPERIDES, JEANNIE MARIE (JEANNIE KAMPERIDES)
Entity type:Individual
Prefix:
First Name:JEANNIE
Middle Name:MARIE
Last Name:KAMPERIDES
Suffix:
Gender:F
Credentials:JEANNIE KAMPERIDES
Other - Prefix:
Other - First Name:JEANNIE
Other - Middle Name:M
Other - Last Name:KAMPERIDES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:38 WEST ST
Mailing Address - Street 2:
Mailing Address - City:WHITMAN
Mailing Address - State:MA
Mailing Address - Zip Code:02382-1328
Mailing Address - Country:US
Mailing Address - Phone:781-447-7186
Mailing Address - Fax:
Practice Address - Street 1:38 WEST ST
Practice Address - Street 2:
Practice Address - City:WHITMAN
Practice Address - State:MA
Practice Address - Zip Code:02382
Practice Address - Country:US
Practice Address - Phone:781-447-7186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-30
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2265801163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse