Provider Demographics
NPI:1164615423
Name:ANDERSON, CAMMY SUE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:CAMMY
Middle Name:SUE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9065 KNOUFF RD.
Mailing Address - Street 2:
Mailing Address - City:PIQUA
Mailing Address - State:OH
Mailing Address - Zip Code:45356-9305
Mailing Address - Country:US
Mailing Address - Phone:937-381-5042
Mailing Address - Fax:
Practice Address - Street 1:9065 KNOUFF RD.
Practice Address - Street 2:
Practice Address - City:PIQUA
Practice Address - State:OH
Practice Address - Zip Code:45356-9305
Practice Address - Country:US
Practice Address - Phone:937-381-5042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-21
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN102502164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse