Provider Demographics
NPI:1154481406
Name:DELGADO, CAMILLE ANGELA (LPN)
Entity Type:Individual
Prefix:
First Name:CAMILLE
Middle Name:ANGELA
Last Name:DELGADO
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:CAMILLE
Other - Middle Name:A
Other - Last Name:DELGADO-PEPE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:24 BROOKLAND FARMS RD
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-5802
Mailing Address - Country:US
Mailing Address - Phone:914-643-6459
Mailing Address - Fax:
Practice Address - Street 1:24 BROOKLAND FARMS RD
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-5802
Practice Address - Country:US
Practice Address - Phone:914-643-6459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-09
Last Update Date:2012-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY249525-1164W00000X
NY647708163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01715200Medicaid