Provider Demographics
NPI:1043635212
Name:ANTIEAU-OLSON, CAMILLE MARIE
Entity Type:Individual
Prefix:
First Name:CAMILLE
Middle Name:MARIE
Last Name:ANTIEAU-OLSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7716 E 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-4602
Mailing Address - Country:US
Mailing Address - Phone:480-815-6582
Mailing Address - Fax:
Practice Address - Street 1:7716 E 1ST AVE
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-4602
Practice Address - Country:US
Practice Address - Phone:480-815-6582
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-25
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN182903163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool