Provider Demographics
NPI:1134457328
Name:GRISSETT, CAMILLE RENEE (RN)
Entity Type:Individual
Prefix:
First Name:CAMILLE
Middle Name:RENEE
Last Name:GRISSETT
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 1:180 WHALEY ST
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11520-4223
Mailing Address - Country:US
Mailing Address - Phone:347-267-4193
Mailing Address - Fax:516-223-4908
Practice Address - Street 1:180 WHALEY ST
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:NY
Practice Address - Zip Code:11520-4223
Practice Address - Country:US
Practice Address - Phone:347-267-4193
Practice Address - Fax:516-223-4908
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-27
Last Update Date:2011-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY530528163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse