Provider Demographics
NPI:1093862179
Name:TICHENOR, CAMILLE MARIE (RN)
Entity Type:Individual
Prefix:MRS
First Name:CAMILLE
Middle Name:MARIE
Last Name:TICHENOR
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 STEWART DAM RD
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:NY
Mailing Address - Zip Code:12822-2721
Mailing Address - Country:US
Mailing Address - Phone:518-885-6884
Mailing Address - Fax:518-885-0077
Practice Address - Street 1:433 GEYSER RD
Practice Address - Street 2:
Practice Address - City:BALLSTON SPA
Practice Address - State:NY
Practice Address - Zip Code:12020
Practice Address - Country:US
Practice Address - Phone:518-885-6884
Practice Address - Fax:518-885-0077
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY523847-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse